DOSE A URETERAL ACCESS SHEATH FACILITATE URETEROSCOPY? (2001)

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Mar 2001DOSE A URETERAL ACCESS SHEATH FACILITATE URETEROSCOPY? JOHN KOURAMBAS, ROBERT R. BYRNE, and GLENN M. PREMINGER JOHN KOURAMBASJOHN KOURAMBAS , ROBERT R. BYRNEROBERT R. BYRNE , and GLENN M. PREMINGERGLENN M. PREMINGER View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66527-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ureteral access sheaths were initially developed to facilitate difficult ureteroscopic access. However, to our knowledge no formal evaluations have been performed to assess the routine use of ureteral access sheaths. Therefore, we prospectively analyzed intraoperative time, symptomatic outcome, major complications, stone-free rate and overall costs related to the routine use of a new ureteral access sheath during standard ureteroscopic procedures. Materials and Methods: Patients undergoing 6.5Fr semirigid or 7.5Fr flexible ureteroscopy were prospectively randomized to unaided ureteroscopy with no access sheath or ureteroscopy via a 12-14Fr ureteral access sheath. Patients who required ureteral dilatation were randomized to the ureteral access sheath used as a dilator or a standard 18Fr ureteral balloon dilator. Patients were evaluated postoperatively on days 0, 1 and 6 with a questionnaire to assess pain, irritative symptoms and complications. The stone-free rate and long-term complications were determined by excretory urography or computerized tomography at 3 months. Results: Enrolled in the study were 59 consecutive patients, who underwent a total of 62 ureteroscopic procedures. Of the 47 patients (76%) who did not require ureteral dilatation 23 (49%) underwent ureteroscopy via the ureteral access sheath and 24 (51%) underwent unaided ureteroscopy. Seven of the 15 patients (28%) who required ureteral dilatation underwent access sheath dilatation, while balloon dilatation was performed in 8. There was no significant difference in postoperative symptoms, complication rate or stone-free status in the access sheath and nonaccess sheath groups in patients not requiring ureteral dilatation (p <0.05). A significant increase in postoperative symptoms was noted when the balloon was used as a dilator compared to the access sheath. Operative time and costs in all patients who underwent access sheath dilatation were less than in those in whom the access sheath was not used. In the 15 patients who required dilatation 71% of access sheath and 100% of balloon dilatations were successful. Conclusions: Routine use of a ureteral access sheath appears to facilitate semirigid and flexible ureteroscopy by decreasing operative time and costs, allowing direct visualization of ureteroscope insertion with simple ureteral re-entry and assisting renal and ureteral access with minimal associated morbidity. A ureteral access sheath should be considered for routine ureteroscopic procedures. References 1 : Endoscopic visualization of the supravesical urinary tract: transurethral ureteropyeloscopy and percutaneous nephroscopy. Semin Urol1985; 3: 60. Google Scholar 2 : Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract. J Urol1987; 138: 280. Link, Google Scholar 3 : Flexible ureteropyeloscopy in the diagnosis of benign essential hematuria. J Urol1990; 143: 549. Link, Google Scholar 4 : Upper urinary tract filling defects: flexible ureteroscopic diagnosis. J Urol1990; 143: 1196. 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Google Scholar From the Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByFulla J, Prasanchaimontri P, Rizk A, Loftus C, Remer E and Monga M (2020) Ureteral Diameter as Predictor of Ureteral Injury during Ureteral Access Sheath PlacementJournal of Urology, VOL. 205, NO. 1, (159-164), Online publication date: 1-Jan-2021.Tapiero S, Kaler K, Jiang P, Lu S, Cottone C, Patel R, Okhunov Z, Klopfer M, Landman J and Clayman R (2021) Determining the Safety Threshold for the Passage of a Ureteral Access Sheath in Clinical Practice Using a Purpose-Built Force SensorJournal of Urology, VOL. 206, NO. 2, (364-372), Online publication date: 1-Aug-2021.Cooper J, François N, Sourial M, Miyagi H, Rose J, Shields J, Sharma N, Domino P, Otto B, Box G, Bird V, Posid T and Knudsen B (2020) The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after UreteroscopyJournal of Urology, VOL. 204, NO. 5, (976-981), Online publication date: 1-Nov-2020.Assimos D (2018) Re: Use of the Ureteral Access Sheath during Ureteroscopy: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 200, NO. 4, (692-694), Online publication date: 1-Oct-2018.Koo K, Yoon J, Park N, Lee H, Ahn H, Lee K, Kim D, Cho K, Chung B and Hong C (2018) The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled StudyJournal of Urology, VOL. 199, NO. 6, (1622-1630), Online publication date: 1-Jun-2018.Kuntz N, Neisius A, Tsivian M, Ghaffar M, Patel N, Ferrandino M, Sur R, Preminger G and Lipkin M (2015) Balloon Dilation of the Ureter: A Contemporary Review of Outcomes and ComplicationsJournal of Urology, VOL. 194, NO. 2, (413-417), Online publication date: 1-Aug-2015.Assimos D (2015) Re: Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective StudyJournal of Urology, VOL. 193, NO. 4, (1276-1276), Online publication date: 1-Apr-2015.Traxer O and Thomas A (2012) Prospective Evaluation and Classification of Ureteral Wall Injuries Resulting from Insertion of a Ureteral Access Sheath During Retrograde Intrarenal SurgeryJournal of Urology, VOL. 189, NO. 2, (580-584), Online publication date: 1-Feb-2013.Wang H, Huang L, Routh J, Kokorowski P, Cilento B and Nelson C (2011) Use of the Ureteral Access Sheath During Ureteroscopy in ChildrenJournal of Urology, VOL. 186, NO. 4S, (1728-1733), Online publication date: 1-Oct-2011.Corcoran A, Smaldone M, Mally D, Ost M, Bellinger M, Schneck F, Docimo S and Wu H (2008) When is Prior Ureteral Stent Placement Necessary to Access the Upper Urinary Tract in Prepubertal Children?Journal of Urology, VOL. 180, NO. 4S, (1861-1864), Online publication date: 1-Oct-2008.Clayman R (2008) Urolithiasis, Endourology and LaparoscopyJournal of Urology, VOL. 179, NO. 5, (1872-1874), Online publication date: 1-May-2008.Harper J, Ebrahimi K, Auge B, Lamberton G, Pham A, Zuppan C, Albala D, Preminger G and Baldwin D (2008) Comparison of a Novel Radially Dilating Balloon Ureteral Access Sheath to a Conventional Sheath in the Porcine ModelJournal of Urology, VOL. 179, NO. 5, (2042-2045), Online publication date: 1-May-2008.Kijvikai K, Haleblian G, Preminger G and de la Rosette J (2007) Shock Wave Lithotripsy or Ureteroscopy for the Management of Proximal Ureteral Calculi: An Old Discussion RevisitedJournal of Urology, VOL. 178, NO. 4, (1157-1163), Online publication date: 1-Oct-2007.Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, Schwartz S, Vanlangendock R, Skenazy J and Landman J (2018) Durability of Flexible Ureteroscopes: A Randomized, Prospective StudyJournal of Urology, VOL. 176, NO. 1, (137-141), Online publication date: 1-Jul-2006.Singh A, Shah G, Young J, Sheridan M, Haas G and Upadhyay J (2018) Ureteral Access Sheath for the Management of Pediatric Renal and Ureteral Stones: A Single Center ExperienceJournal of Urology, VOL. 175, NO. 3, (1080-1082), Online publication date: 1-Mar-2006.MONGA M, BEST S, VENKATESH R, AMES C, LIEBER D, VANLANGENDOCK R and LANDMAN J (2018) PROSPECTIVE RANDOMIZED COMPARISON OF 2 URETERAL ACCESS SHEATHS DURING FLEXIBLE RETROGRADE URETEROSCOPYJournal of Urology, VOL. 172, NO. 2, (572-573), Online publication date: 1-Aug-2004.Weizer A, Auge B, Silverstein A, Delvecchio F, Brizuela R, Dahm P, Pietrow P, Lewis B, Albala D and Preminger G (2018) Routine Postoperative Imaging is Important After Ureteroscopic Stone ManipulationJournal of Urology, VOL. 168, NO. 1, (46-50), Online publication date: 1-Jul-2002.WU N, AUGE B and PREMINGER G (2018) SIMPLIFIED URETERAL STENT PLACEMENT WITH THE ASSISTANCE OF A URETERAL ACCESS SHEATHJournal of Urology, VOL. 166, NO. 1, (206-208), Online publication date: 1-Jul-2001. Volume 165Issue 3March 2001Page: 789-793 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsureterurinary calculiendoscopyureteroscopyMetricsAuthor Information JOHN KOURAMBAS More articles by this author ROBERT R. BYRNE More articles by this author GLENN M. PREMINGER More articles by this author Expand All Advertisement PDF DownloadLoading ...