MP89-13 IS IT SAFE TO USE A URETERAL ACCESS SHEATH IN AN UNSTENTED URETER?

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2018MP89-13 IS IT SAFE TO USE A URETERAL ACCESS SHEATH IN AN UNSTENTED URETER? Asaf Shvero, Dorit Zilberman, Jacob Ramon, Harry Winkler, and Nir Kleinmann Asaf ShveroAsaf Shvero More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , Jacob RamonJacob Ramon More articles by this author , Harry WinklerHarry Winkler More articles by this author , and Nir KleinmannNir Kleinmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2953AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral access sheaths (UASs) are being commonly used during URS in order to decrease intra-renal pressure, improve visability, and provide easy access to the pelvico-calyceal system; therefore, reducing the risk of bleeding and infections. Several reports claim that the use of UAS might cause severe damage to the ureteral wall, tissue ischemia, and consequently reperfusion damage and benign ureteral strictures. The objective of this study was to determine the rate of clinically significant ureteral strictures following the use of ureteral access sheaths in an unstented ureter during ureteronephroscopy and laser lithotripsy, and to compare complications of small and large-diameter UAS. METHODS Medical files of patients undergoing ureteronephroscopy between 2103-2016 at our medical center were reviewed. Patients undergoing URS for stone disease with the use of UAS in an unstented ureter were included. Two sizes of UAS were used: COOK Medical Flexor 12/14Fr (wide) and 9.5/11.5Fr (narrow). Exclusion criteria: presence of impacted ureteral stones, prior ureteroscopies, prior ureteral drainage (double-J ureteral stent or PCN), documented ureteral strictures, presence of renal or ureteral malignancy, patients who were lost to follow-up or lacked post-surgical imaging were also excluded.The primary outcome of the study was to evaluate stricture formation. Strictures were defined as new hydronephrosis with delayed secretion in renal scan. Secondary outcomes were occurrence of flank pain, elevated serum creatinine level, and UTIs in the follow-up period. RESULTS The cohort included 165 patients, at a median age of 57 years (62% males). Among them, in 86 patients, a narrow UAS was used, and in 79 a wide UAS. Average number of stones was 1.5 and 1.6, and stone burden was 2.3 and 3.4 cm3, in the narrow and wide groups, respectively. Stone burden was significantly higher in the wider UAS group in univariate analysis, but on multivariate analysis there was no significant difference (p=0.066). Out of the 86 cases where a narrow UAS was used, in 13 (15%) an insertion of the wider UAS failed. In 5 cases serial ureteral dilators were used before introduction of a narrow UAS. On follow-up there was no case of new hydronephrosis. When comparing the 2 sizes of UAS, the wider UAS was used in cases of significantly larger stone burden, older patients, with more co-morbidities. In addition, stone free rate was higher in the wide compared to the narrow UAS group (83.5% vs. 70.9% respectively).Intra-operative complications were very rare: only 1 procedure in the narrow UAS group was stopped due to bleeding which impaired visualization. In the wide UAS group, no complication was recorded. CONCLUSIONS The use of UAS during URS in an unstented ureter is safe and does not involve high rates of ureteral stricture formation. The use of wider sheaths does not correlate with higher complications rate. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1210-e1211 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Asaf Shvero More articles by this author Dorit Zilberman More articles by this author Jacob Ramon More articles by this author Harry Winkler More articles by this author Nir Kleinmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...