PD23-08 URETERAL ACCESS SHEATHS AND URETERAL WALL INJURY: A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-08 URETERAL ACCESS SHEATHS AND URETERAL WALL INJURY: A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL Christopher J. Loftus, Vishnuvardhan Ganesan, Olivier Traxer, Jesse Schold, Mark Noble, Sri Sivalingam, Nicolas Muruve, and Manoj Monga Christopher J. LoftusChristopher J. Loftus More articles by this author , Vishnuvardhan GanesanVishnuvardhan Ganesan More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Jesse ScholdJesse Schold More articles by this author , Mark NobleMark Noble More articles by this author , Sri SivalingamSri Sivalingam More articles by this author , Nicolas MuruveNicolas Muruve More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral access sheaths have been suggested to improve outcomes with flexible ureteroscopy, yet placement may be difficult or associated with ureteral injury. We conducted a randomized trial of the Boston Scientific Navigator HDTM and Cook FlexorTM ureteral access sheaths to evaluate ease of placement and risk of ureteral wall trauma. METHODS Ninety patients were consented and randomized to ureteroscopy with the Cook Flexor or the Boston Scientific Navigator HD 12/14Fr sheaths. Pre-stented patients were excluded. At the completion of the procedure, video of the intraluminal ureter was recorded as the sheath was withdrawn. Videos were analyzed by two blinded staff endourologists who scored ureteral injury on a standard 5-point scale (0 to 4). If the initial sheath failed to advance, the patient was crossed over to the other sheath for a trial of passage and excluded from video review. RESULTS Patients had a mean cumulative stone diameter of 13.1±10.9mm and stone surface area burden of 1165±1065mm2. The success rate for initial sheath placement was 86.6%; placement rate and did not differ for sheaths groups. In no case did the Flexor sheath advance where the Navigator had failed while the Navigator was successful in passage in 50% (3/6) of the Flexor failures. The Navigator HD was subjectively rated as easier to place (3.4 vs 2.9, p=0.029). Grade 1 injury was seen in 24.6%, grade 2 in 11.5% and grade 3 in 6.5%; there was no difference in rate of injury between sheaths. There were no grade 4 injuries. Male gender, large stone burden, longer time of sheath insertion and a more difficult subjective rating for sheath placement were associated with high grade (grade 2 or 3) ureteral injury. Post-operative complication rate was 11.1% and similar between zero/low and high grade injury groups. CONCLUSIONS No significant difference in the risk of ureteral wall injury was noted between the two sheaths tested. Both a subjectively difficult sheath placement and a longer time of placement were associated with high grade injury, suggesting that surgeons should carry a low threshold for switching to a smaller sheath when resistance is felt. Though ureteral wall injury was not associated with any perioperative complications, long-term follow-up will be required to monitor for risk of stricture formation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e508-e509 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Christopher J. Loftus More articles by this author Vishnuvardhan Ganesan More articles by this author Olivier Traxer More articles by this author Jesse Schold More articles by this author Mark Noble More articles by this author Sri Sivalingam More articles by this author Nicolas Muruve More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...