1541 URETERAL WALL INJURIES INDUCED BY URETERAL ACCESS SHEATH DURING RETROGRADE INTRA-RENAL SURGERY (PROSPECTIVE EVALUATION)

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20121541 URETERAL WALL INJURIES INDUCED BY URETERAL ACCESS SHEATH DURING RETROGRADE INTRA-RENAL SURGERY (PROSPECTIVE EVALUATION) Saeed Al-Qahtani, Alexandre Thomas, Thibaud Saussez, Sixtina Gil-Diez de Medina, and Olivier TRAXER Saeed Al-QahtaniSaeed Al-Qahtani Paris, France More articles by this author , Alexandre ThomasAlexandre Thomas Paris, France More articles by this author , Thibaud SaussezThibaud Saussez Paris, France More articles by this author , Sixtina Gil-Diez de MedinaSixtina Gil-Diez de Medina Paris, France More articles by this author , and Olivier TRAXEROlivier TRAXER Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral access sheaths (UASs) have been developed to facilitate flexible ureteroscopy and to improve irrigation flow. Nevertheless, outside diameter is ranged from 9.5 Fr to 17.5 Fr in comparison with mean ureteric wall diameter that is usually estimated at 9 Fr. We assessed the ureteric injuries during flexible ureterorenoscopy caused by ureteral access sheath. Clinical predictors of the severity of ureteric injuries were evaluated. METHODS We prospectively evaluated 136 patients who underwent retrograde intra-renal surgery (RIRs) using ureteral access sheath from March 2010 to october 2010 in two different centrers. There were 92 men and 44 women with mean age was 51.6 years (ranged from 14 to 84). All UAS were 12 - 14 Fr. Group of patients (39.7 %) were pre-stented. At the end of procedure, ureteric injuries were evaluated clinically through endoscopic exploration. Therefore, we presented our classification of ureteric endoscopic injuries based on the anatomy of ureteric wall. When different types of injuries coexist, the higher grade was documented. Factors that affect clinical outcomes were evaluated statistically. RESULTS From our data, 68 patients (50%) had no ureteric injury at the end of procedure. On the other hand, 68 patients had at least one iatrogenic injury of the ureteric wall. We reported, 47 patients with ureteral injury grade 1 (35%), 15 with grade 2 (11%) and 6 with ureteric perforation (4%). Patients characteristics such as age, gender, body mass index and history of previous ureteroscopy were not statistically significant. Nevertheless, the incidence of ureteric injuries was significantly lower in pre-stenting patients (p<0.0001). Moreover, operative time was correlated to the icidence of ureteraic injuries (p=0.031). CONCLUSIONS Insertion of ureteral access sheath during RIRS procedure may induce severe ureteric injuries. Ureteral pre-stenting reduces significantly the incidence of this complication. Classification (grade) Endoscopic findings 0 No lesion 1 Mucosal erosion of ureter without injury of smooth muscle 2 Injury of ureteral wall including mucosa and smooth muscle with preservation of adventitia (peri-ureteral fat is not visible) 3 Injury of ureteral wall including mucosa and smooth muscle with perforation of adventitia (peri-ureteral fat is visible) © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e623-e624 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saeed Al-Qahtani Paris, France More articles by this author Alexandre Thomas Paris, France More articles by this author Thibaud Saussez Paris, France More articles by this author Sixtina Gil-Diez de Medina Paris, France More articles by this author Olivier TRAXER Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...