The clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope

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Objective To investigate the clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope. Methods From March 2013 to July 2015, there were 68 patients accepted a ureteral access sheath in flexible ureteroscopy with the help of rigid ureteroscope for the treatment of kidney stones. There were 46 cases male, 22 cases female, aged from 22 to 76 years old, average 43.9 years. There were 68 cases with backaches or hematuria. There were 48 cases with single stone, 20 patients with multiple stones. There were 5 cases with stones on both sides. The stone diameter were from 1.2 to 2.5 cm, the average (1.83 ±0.16) cm. There was no hydronephrosis in 18 cases, mild hydronephrosis 42 cases. The operations were carry out under general anesthesia. By using rigid ureteroscope placed zebra guidewire, then intercept F8 single lumen tip to 1.0 cm section on rigid ureteroscope, was placed into a modified 42 cm ureteral access sheath. Then the modified 42 cm ureteral access sheath was inserted under direct view with the help of rigid ureteroscope. Preoperative patient characteristics, radiographic stone size, operation time, success rate of lithotripsy, serious complications especially ureteral injury was recorded.4 weeks and 12 weeks after operation, ultrasound and/or CT were re-examined to assess the success rate of lithotripsy and the incidence ureteral stricture. Results All the procedures were successful. The operation time was (62.2±6.5 )min, the hospital stay was (3.1±0.2)d. The success rate of ureteral access sheath completely placement was 97.1%, partially placement was 2.9%. Postoperative complications included Clavien classification grade I 6 cases and grade II 2 cases. The postoperative follow-up averaged (12±1.2) months for all case. The success rate of lithotripsy was 76.5% in 4 weeks postoperative, and it was 95.6% in 12 weeks. During the follow-up, compared with the preoperative cases, 62 cases were not found to increase the degree of hydronephrosis. There were 58 cases (58/62) without hydronephrosis. 4 cases were mild hydronephrosis (4/62). CT showed normal ureter 52 cases (52/52). Conclusions It was safe and reliable procedure with good results. It would be a safe procedure to inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope. Key words: Ureteral access sheath; Flexible ureteroscopy; Lithotripsy, laser