Practice patterns of ureteral access sheath during ureteroscopy for nephrolithiasis: a survey among endourologists worldwide

Dorit Esther Zilberman,Harry Winkler,Alon Lazarovich,Nir Kleinmann

doi:10.1186/s12894-019-0489-x

Dorit Esther Zilberman, Harry Winkler + Show 2 more

Open Access

https://doi.org/10.1186/s12894-019-0489-x

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Journal: BMC Urology	Publication Date: Jul 4, 2019
Citations: 14	License type: open-access

Affiliation: Sheba Medical Center, Tel Aviv University

Abstract

BackgroundThe use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide.MethodsA 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use.The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists.The survey was then distributed via e-mail to all the Endourological Society members.Results216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%).ConclusionsUAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.

Highlights

The use of ureteral access sheath (UAS) during ureteroscopy is controversial
Questions and responses are detailed in Table 1. 99.53% of the respondents practice as endourologists, almost two thirds of whom are fellowship trained endourologists and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility, either in a university hospital or both university hospital and private practice. 77.3% perform at least 100 ureteroscopies annually
The 12/14 access sheath is the most common (44.5 and 46%, respectively). 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% believe the application of UAS does not increase postoperative complications rate, and if the latter does occur, most likely it is either a ureteral stricture (93.2%) or pain (48%)

Summary

Introduction

The use of ureteral access sheath (UAS) during ureteroscopy is controversial. The ureteral access sheath (UAS) was first introduced in 1974 [1]. The critics, on the other hand, emphasize traumatic insertion and the pressure the UAS poses over the ureteric tissue that in turn may result in ischemic injury and ureteric strictures [11,12,13,14]. Per their doctrine, UAS has no influence neither on SFR [4, 15] nor on total operative time [4]. It might contribute to higher rates of postoperative complications [16] and longer hospital stay [4]

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