Ureteral access sheath during retrograde flexible uretero-renoscopy: safe tool or safety hazard?

Abstract

Objectives: To evaluate the morbidity of ureteral access sheath (UAS) use during retrograde flexible ureteroscopy, and after a minimum follow-up period of 18 months. Methodology: We prospectively evaluated 237 patients treated by retrograde flexible ureteroscopic approach for single pyelocaliceal stones: 126 in which a 10/12F UAS was used were compared with 111 in which the procedure was performed without it. Patients were followed for at least 18 months. 15% of the first group and 12.6% of the second one were JJ stented preoperatively. UAS related ureteral wall injuries we recorded in 36.5%. According to Traxer classification, 32.5% were grade 1 injuries, 3.2% were grade 2 injuries and 0.8% grade 3 injuries. Perioperative complications rate were similar among the two groups (11.1% vs. 14.4%), septic ones being significantly reduced in the study group (28.3% vs. 68.7% out of the total complication cases. 22 patients were lost for follow-up. At 18 months one case with stenosis of the ureteral orifice was encountered in the control group. Conclusions: Prudent use of UAS does not increase the complication’ rates specific for the flexible ureteroscopic approach. It seems to be associated with less septic complications, probably by maintaining a low pressure in the collecting system.