MP35-03 SAFE PASSAGE OF 16 FR URETERAL ACCESS SHEATHS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP35-03 SAFE PASSAGE OF 16 FR URETERAL ACCESS SHEATHS Sohrab N. Ali, Amanda McCormac, Minh-Chau Vu, Andrew S. Afyouni, Mitchell O'Leary, Kathryn Osann, Michael Klopfer, Zachary E. Tano, Pengbo Jiang, Roshan M. Patel, Jaime Landman, and Ralph V. Clayman Sohrab N. AliSohrab N. Ali More articles by this author , Amanda McCormacAmanda McCormac More articles by this author , Minh-Chau VuMinh-Chau Vu More articles by this author , Andrew S. AfyouniAndrew S. Afyouni More articles by this author , Mitchell O'LearyMitchell O'Leary More articles by this author , Kathryn OsannKathryn Osann More articles by this author , Michael KlopferMichael Klopfer More articles by this author , Zachary E. TanoZachary E. Tano More articles by this author , Pengbo JiangPengbo Jiang More articles by this author , Roshan M. PatelRoshan M. Patel More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During ureteroscopic stone therapy, the insertion of a 14 Fr ureteral access sheath (UAS) results in significant ureteral trauma in upwards of 20% of patients. In attempts to avert such injury, we developed a proprietary UAS force sensor. Our studies indicated that maintaining the force of insertion below 6 N would allow for non-injurious insertion of even a 16 Fr UAS. Herein, we sought to identify the clinical factors associated with the safe deployment of a 16 Fr UAS. METHODS: Two hundred and thirty-eight patients (250 renal units) were subject to having UAS insertion forces recorded. In each case, an attempt was made to initially pass a 16 Fr UAS; if 6 N was reached, the surgeon was advised to downsize to a 14 Fr UAS and if 6 N was again reached, the surgeon was advised to downsize to a 12 Fr UAS. A post-ureteroscopic lesion scale (PULS) was recorded for each case to assess for ureteral injury. Regression models were created to estimate the impact of adjusted variables on PULS value, 16 Fr UAS deployment, and maximum UAS insertion force. RESULTS: A 16 Fr UAS was deployed in 145 (58%) renal units with a mean maximum force of 5.5 N. Two renal units with high-grade ureteral injuries (PULS=3) were noted; however, in both cases, the safety threshold (6 N) was exceeded: 8.36 N and 8.91 N. Preoperative stents were strongly associated with successful passage of a 16 Fr UAS independent of tamsulosin (OR 3.184, p=0.002). Recently treated bacteriuria (OR 1.988, p=0.033), and preoperative antibiotics (OR 1.96, p=0.014) were also independent predictors of successful 16 Fr UAS deployment. Preoperative administration of tamsulosin was not found to be beneficial. CONCLUSIONS: Maintaining an insertion force of ≤ 6 N can avoid significant UAS associated ureteral injuries. Preexisting indwelling stents, recently treated bacteriuria, and preoperative antibiotics favored safe insertion of a 16 Fr UAS. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e469 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab N. Ali More articles by this author Amanda McCormac More articles by this author Minh-Chau Vu More articles by this author Andrew S. Afyouni More articles by this author Mitchell O'Leary More articles by this author Kathryn Osann More articles by this author Michael Klopfer More articles by this author Zachary E. Tano More articles by this author Pengbo Jiang More articles by this author Roshan M. Patel More articles by this author Jaime Landman More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...