Ureteral access sheaths in RIRS: a retrospective, comparative, single-center study.

Abstract

To evaluate the use of ureteral access sheaths (UAS) in reducing operative time and complications, as well as improving stone-free rates (SFR), while assessing their overall safety and efficiency. Data regarding 234 patients who underwent retrograde intrarenal surgery (RIRS) for stones up to 3 cm between January 2017 and March 2020 were retrospectively analyzed. About 52.5 % of procedures were performed utilizing a UAS. Differences in operative time, fluoroscopy time, stone-free rate, and complications were analyzed between procedures with and without UAS and stratified, according to stone burden size, into three groups (Group A: 0.5-1 cm; Group B: 1-2 cm; Group C: 2-3 cm). Operative time, fluoroscopy time, and residual fragments size were lower in RIRS without UAS, respectively, 54.27±24.02 vs. 62.23±22.66 min (p=0.010), 2.72±0.89 vs. 4.44±1.67 min (p<0.0001), and 3.85±0.813 vs. 4.60±0.83 mm (p=0.011). Considering stone burden, operative time was lower in RIRS without UAS for Group A (36.40±8.555 vs. 46.05±6.332 min) (p<0.0001) while higher for Group B (60.39±18.785 vs. 50.14±5.812 min) (p=0.002). Similarly, fluoroscopy time was lower in RIRS without UAS in every group, respectively, 2.11±0.34 vs. 2.74±0.57 min (p<0.0001), 2.94±0.51 vs. 4.72±0.37 min (p<0.0001), and 3.78±1.26 vs. 6.79±1.17 min (p<0.0001). Only Group C had a statistically significant difference in residual fragment size without UAS(3.89±0.782 vs. 4.75±0.886 mm) (p=0.050). UAS should be carefully evaluated considering the increased fluoroscopy time and the differences in operative time related to different stone burdens.