Impact of Ureteral Access Sheath during Flexible Ureteroscopy as Regard Complication and Stone Free Rate

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Abstract Background Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question. Objective To compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. Patients and Methods 120 patients with symptomatic upper ureteric and renal pelvic stone disease were enrolled, they were divided into 2 equal groups one underwent FURS with UAS and the second group underwent FURS without UAS. Results There was a statistically significant higher frequency of postoperative complications in No UAS comparing to UAS group with p-value (p < 0.05) in the form of Postoperative fever and Postoperative sepsis. While, there is no statistically significant difference between groups according to OR time (min.), Stone free rate, Hospital stay (hrs.) and Postoperative pain. Conclusion In the current study we aimed to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. In the included patients, There was a statistically significant higher frequency of postoperative sepsis and fever in No UAS comparing to UAS group, with p-value (p < 0.05). While, there is no statistically significant difference between groups according to operative time “min”, Stone free rate, Hospital stay (hrs.) and Postoperative pain. Moreover, significant association of postoperative sepsis and fever with residual stones in included patients. UAS has superior advantage over no-UAS due to lower incidence of sepsis and fever in the current study.