Abstract
Introduction: To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. In case pre-stenting becomes an option, how long does it need to be stented. 
 Materials and Methods: After obtaining approval from Institutional Review Board and informed consent, a prospective randomized controlled study was conducted in the Department of Urology, Bir Hospital for 18 months. All the patients enrolled for retrograde intrarenal surgery were grouped into 3 groups: Group 1 – without pre-stenting, Group 2 – one week of pre-stenting, and Group 3 – two weeks of pre-stenting. Success was defi ned as an ability to accommodate a 10/12 F ureteral access sheath during retrograde intrarenal surgery. Ureteral access sheath induced ureteric wall injury was also taken into consideration.Results: Among 179 cases, 152 cases were included in the study. In 36 patients out of 53 (67.92%) in group 1, 10/12 F ureteral access sheath was negotiable without pre-stenting, marking the frequency of distensible ureters. In 44 patients out of 47 (93.66%) from group 2 and all 52 patients (100%) from group 3, ureteral access sheath placement was successful after one and two weeks of pre-stenting respectively. Ureteric wall injury of grade1 and 2, was found in 9 patients (5.9%).Conclusions: The majority of ureters (67.92%) are distensible, not requiring pre-stenting before retrograde intrarenal surgery. One and two weeks of pre-stenting carries a success rate of 93.66% and 100% respectively.
Highlights
To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting
Since there has not been any consensus about the need and duration of pre-stenting before RIRS, we aim to evaluate prospectively if pre-stenting seems to be mandatory
Success was defined as an ability to accommodate ureteral access sheath (UAS) of 10/12 F during RIRS
Summary
To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. Retrograde intrarenal surgery (RIRS), currently regarded as one of the first-line treatments for renal stone < 2 cm.[1] With the advancement in endoscopic techniques in terms of miniaturization and increased flexibility, RIRS has become widely accepted and has further been facilitated by the use of ureteral access sheath (UAS).[2,3] Insertion of UAS is not free of complication and about 46.5 % of direct ureteral injury has occurred during its negotiation in the ureter.[4] To overcome this avoidable complication, the ureter can be dilated by active or passive means, prior to the placement of UAS.[5]. The active form of dilatation by various dilators produces linear shearing force with incisions in the ureteric mucosa, resulting in extravasation of irrigation fluid and urine is believed to cause fibrosis.[6] Pre-stenting has the advantage of passively dilating the ureter allowing for easier access to the upper urinary tract and
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