Use Of Access Sheath Research Articles

Comparison between Flexible Ureteroscopy by Using Uretral Access Sheath and Flexible Ureterosopy without Using Ureteral Access Sheath in Cases of Upper Ureteric and Pelvic Stones

Abstract Background Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question. Aim of the Work to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. Patients and Methods This randomized controlled clinical trial was conducted in Urology Department, Ain Shams, University Hospitals and included 50 upper ureteric stone disease patients. They were divided into 2 comparative groups (each group 25 patients) by closed envelop method. One of these groups underwent FURS with ureteral access sheath and the second group underwent FURS without ureteral access sheath. Results there was no significant difference between the 2 groups regarding demographic or clinical data. Moreover, no significant difference was detected between the 2 groups regarding intra or post-operative complications, stone free rate or duration of hospital stay. However, statistically significant longer operative time was recorded in UAS group compared to no UAS group. Conclusion our study showed that flexible ureterenoscopy without ureteral access sheath Seems to be safe as flexible ureterenoscopy with ureteral access sheath regards intraoperative, post- operative complications, patient satisfaction, stone free rate and duration of hospital stay, an additional advantage is shorter operative time without using of ureteral access sheath

Impact of Ureteral Access Sheath during Flexible Ureteroscopy as Regard Complication and Stone Free Rate

Abstract Background Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question. Objective To compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. Patients and Methods 120 patients with symptomatic upper ureteric and renal pelvic stone disease were enrolled, they were divided into 2 equal groups one underwent FURS with UAS and the second group underwent FURS without UAS. Results There was a statistically significant higher frequency of postoperative complications in No UAS comparing to UAS group with p-value (p < 0.05) in the form of Postoperative fever and Postoperative sepsis. While, there is no statistically significant difference between groups according to OR time (min.), Stone free rate, Hospital stay (hrs.) and Postoperative pain. Conclusion In the current study we aimed to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. In the included patients, There was a statistically significant higher frequency of postoperative sepsis and fever in No UAS comparing to UAS group, with p-value (p < 0.05). While, there is no statistically significant difference between groups according to operative time “min”, Stone free rate, Hospital stay (hrs.) and Postoperative pain. Moreover, significant association of postoperative sepsis and fever with residual stones in included patients. UAS has superior advantage over no-UAS due to lower incidence of sepsis and fever in the current study.

Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.

Introduction: The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration vs its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing URS were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; I2 = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; I2 = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; I2 = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; I2 = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; I2 = 91%; PI 0.47-2.59). Conclusion: Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.

Factors affecting the success and perioperative complications of retrograde intrarenal surgery: a retrospective clinical analysis

Background and objective: Many factors are presumed to have an impact on the results of retrograde intra renal surgery. In the current study, our objective was to actuate the possible factors influencing the stone-free rates and complications post lone-session retrograde intrarenal surgery for renal calculi. Stone-free rates Methods: Overall 200 patients who undergone retrograde intra renal surgery between January 2019 and March 2022 were evaluated, retrospectively. Success was decided if there were no residual fragments on pain X-ray and ultrasonography. Patient demographics, stone characteristics, perioperative data were assessed and analyzed to actuate predictive factors influencing stone-free rates and perioperative morbidities. Results: Two hundred patients with a mean age of 41.12±14.37 years were evaluated. The mean stone size was 1.815 ± 2.107 millimeters (mm), mean stone density was 969.63 ± 345.307 Hounsfield unit. The immediate SFR was (76.8±0.42) while the final SFR (single session) was 87.9±0.46. Thirty-seven patients (18.5%) developed complications, the preponderance of them 86% were minor complications (Clavien grade I and II). In multivariate regression analysis, multiple renal stones and ureteral access sheath use were constitute to be statically significant predictors of stone-free status. Moreover, multivariate regression analysis revealed that operative time, lasing time and stone opacity stones were statistically significant factors influencing perioperative complications. Conclusion: Success rates inversely related to stones number and ureteral access sheath usage. While prolonged operation time, lasing time, and higher stone density could be a more reliable predictor of perioperative complication development.

Evaluation of the effect of 9.5/11.5-fr ureteral access sheath use on acute kidney injury with the myo-inositol oxygenase biomarker in patients undergoing retrograde intrarenal surgery: a prospective, randomized, and controlled study

Introduction We aimed to investigate whether a low intrarenal pressure provided by ureteral access sheath (UAS) use had a positive effect on the prevention of acute kidney injury through the evaluation of the myo-inositol oxygenase (MIOX). Material and methods The patients were divided into two groups according to whether a 9.5/11.5-Fr UAS was used during retrograde intrarenal surgery (RIRS): UAS group and non-UAS group. RIRS was performed under gravity irrigation and manual pumping was not used. For the measurement of MIOX, 5 cc blood samples were taken from the patients preoperatively and four hours postoperatively. Results Operation time and hospital stay were significantly longer in the UAS group. The mean preoperative and postoperative MIOX values were 0.77 ± 0.36 ng/ml and 0.74 ± 0.38 ng/ml, respectively, in the UAS group, and 0.74 ± 0.31 ng/ml and 0.83 ± 0.40 ng/ml, respectively, in the non-UAS group. The mean MIOX change was −0.29 ± 0.36 in the UAS group and 0.08 ± 0.44 in the non-UAS group, indicating no significant difference between the groups. Conclusion Even if UAS is not used, significant acute kidney injury is not observed under gravity irrigation and therefore, if we avoid manual pumping, the intrarenal pressure remains low, thus potentially rendering the use of 9,5/11,5-Fr UAS unnecessary.

Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Is It a Good Strategy to Proceed a Retrograde Intrarenal Surgery Session Sheathless After Ureteral Access Sheath Insertion Failure? A RIRSearch Study.

Objectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless (n = 110, Group 1) and those who proceeded without UAS after insertion failure (n = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS (p = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) (p = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p = 0.001). Stone burden (odds ratio [OR]: 1.002, p = 0.019) and stone density (OR: 1.002, p = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

Endourological treatment of upper tract urinary disease in children

With advances in therapeutic interventions, endourology has become standard of care for the treatment of numerous diseases in the field of pediatric urology. However, there remains a lack of agreement and evidence on the optimal approaches and associated complications of endourological treatment of upper urinary tract conditions in children, namely ureteropelvic junction (UPJ) obstruction, primary obstructive megaureter, and nephrolithiasis. While pyeloplasty remains the first-line surgical treatment for pediatric UPJ obstruction, endoscopic retrograde balloon dilatation (ERBD) and endopyelotomy continue to gain traction as less invasive means of treating obstruction, particularly for failed repairs. Studies report success rates ranging from 76–100% although re-stenosis or need for revision surgery is not uncommon. Endourological options for the surgical management of primary obstructive megaureter include ERBD or endoureterotomy, rather than the open option of ureteroneocystotomy with or without tapering. Both have shown long-term success rates ranging from 70–90%, however, there is emerging evidence that these therapies may be associated with a risk of postoperative vesicoureteral reflux. Meanwhile, for stone disease, shock wave lithotripsy (SWL), flexible ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are mainstays in the pediatric urologist’s armamentarium. Studies have shown that URS and PCNL have comparable stone-free rates, although PCNL can be associated with increased morbidity. Advancements in technology have led to the use of smaller access sheaths without compromising stone-free rates or increasing long-term complications. The use of mini-PCNL in the adult population holds great potential for use in our pediatric patients. The rise of endourology expertise and improved technology makes it an attractive option that could even be considered as a first-line option for the treatment of various urinary tract conditions. Nevertheless, there is a paucity of evidence on outcomes and complications following its use for treatment of upper urinary tract diseases in children. This review aims to summarize and present results of endourological treatments for pediatric UPJ obstruction, primary obstructive megaureter, and nephrolithiasis, as well as highlight advancements in the field of endourology that may increase its utilization in pediatric urology in the future.

V02-05 FIRST-IN-HUMAN EXPERIENCE WITH THE LITHOVUE TM ELITE SINGLE USE URETEROSCOPE: IMPACT OF UAS ON INTRARENAL PRESSURE

You have accessJournal of UrologyCME1 Apr 2023V02-05 FIRST-IN-HUMAN EXPERIENCE WITH THE LITHOVUETM ELITE SINGLE USE URETEROSCOPE: IMPACT OF UAS ON INTRARENAL PRESSURE Ben H. Chew, Abdulghafour Halawani, Kyochul Koo, Victor K. F. Wong, and Naeem Bhojani Ben H. ChewBen H. Chew More articles by this author , Abdulghafour HalawaniAbdulghafour Halawani More articles by this author , Kyochul KooKyochul Koo More articles by this author , Victor K. F. WongVictor K. F. Wong More articles by this author , and Naeem BhojaniNaeem Bhojani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We described the 1st in human use of the novel pressure sensing digital flexible ureteral scope, LithoVue Elite (Boston Scientific). By measuring intrarenal pressure in renal time, we were able to determine if the pressure may become elevated and contribute to potential postoperative complications. METHODS: The LithoVue Elite Ureteroscope was used clinically and the first in human cases have occurred in Canada. A pressure bag set at 150 mmHg was used for pressurized irrigation. A ureteral access sheath was used at the discretion of the surgeon. Pressure readings were delivered 4 times a second. Readings of the intrarenal pressure are displayed on the video interface where the endoscopic image is viewed in real time (Figure 1). RESULTS: Two cases are discussed here. One case shows that the intrarenal pressure with a ureteral access sheath ranges between 25-30 mmHg. In the exact same patient on the other kidney, no ureteral access sheath was used and the pressure is seen to be approximately 100 mmHg. Another case shows a patient under spinal anesthesia. When the pressure goes >115 mmHg, the patient describes pain and insertion of a UAS lowers the pressure to 15 mmHg and her pain subsides. CONCLUSIONS: The LithoVue Elite ureteroscope was able to monitor intrarenal pressure in real time. Ureteral access sheath use in these 2 cases showed a decrease in intrarenal pressure and where the patient was awake under spinal anesthetic, a UAS decreased her pain from high intrarenal pressure. The use of a new ureteroscope that can monitor intrarenal pressure in real time will help further investigation of the effects of intrarenal pressure during and after ureteroscopy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e169 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ben H. Chew More articles by this author Abdulghafour Halawani More articles by this author Kyochul Koo More articles by this author Victor K. F. Wong More articles by this author Naeem Bhojani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP23-20 A SINGLE CENTER COMPARATIVE STUDY OF TWO SINGLE USE DIGITAL FLEXIBLE URETEROSCOPY IN THE MANAGEMENT OF RENAL STONES LESS THAN 2 CM

You have accessJournal of UrologyCME1 Apr 2023MP23-20 A SINGLE CENTER COMPARATIVE STUDY OF TWO SINGLE USE DIGITAL FLEXIBLE URETEROSCOPY IN THE MANAGEMENT OF RENAL STONES LESS THAN 2 CM Fouad Zanaty, Mohamed Elshazly, Hossam Kandeel, and Baher Salman Fouad ZanatyFouad Zanaty More articles by this author , Mohamed ElshazlyMohamed Elshazly More articles by this author , Hossam KandeelHossam Kandeel More articles by this author , and Baher SalmanBaher Salman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For renal stones <2 cm, guidelines recommend the use of retrograde intrarenal surgery as a first line treatment option. Many available single use flexible ureteroscopy were found. We aim to compare the effectiveness of two single use flexible ureteroscopy; Pusen uscope 3011 versus LithoVue in the management of renal stones less than 2 cm. METHODS: Our study prospectively included 60 patients equally divided in to 2 groups; Pusen group and LithoVue group during the period from June 2020 to June 2021. The included patients were above 18 years old. Perioperative details as operative time, fluoroscopy time, hospital stay and complications were recorded. Stone free rate was assessed. Base purchase cost was also compared. RESULTS: There was no statistically significant difference between the 2 groups regarding age, gender and body mass index (BMI), stones size, side, number and location. The perioperative evaluation and outcome had no statistically significant differences between the 2 groups regarding the operative time, hospital stay, access sheath use, and stone free rate or radiation exposure. Among all cases we had 49 cases (81.6%) with no postoperative complications (21 cases for Pusen group and 28 cases for Lithovue group). The incidence of postoperative complications was significantly higher among Pusen group than lithoVue group (p=0.02). Initial purchase cost for both FURS had no significant difference (p=0.86). CONCLUSIONS: RIRS can be performed effectively with Pusen 3011 and LithoVue single use flexible ureteroscopy in patients diagnosed with renal calculi <2 cm with superior outcomes with LithoVue. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e314 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fouad Zanaty More articles by this author Mohamed Elshazly More articles by this author Hossam Kandeel More articles by this author Baher Salman More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment of factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital of Nepal

Retrograde intrarenal surgery (RIRS) is an effective and safe method for the management of intrarenal stone showing high stone-free rates. Its main advantage is decrease in operative morbidity for the patient, as well as a faster recovery. The current study aimed to study the factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital. It is an observational descriptive cross sectional study using purposive sampling method which was conducted among 188 patients who underwent retrograde intrarenal surgery (RIRS) for management of nephrolithiasis in Department of Urology of B&amp;B hospital, Lalitpur, Nepal. The baseline information of the factors affecting operating time were obtained like age, gender, site of renal stone, prestented or not, body mass index (BMI), ureteral access sheath (UAS) use, stone volume and stone density. The mean operating time was high in renal stone with calcium ammonium urate composition. On linear regression analysis, operative times significantly increased with greater stone volumes and also pre-stenting and ureteral access sheath use did significantly difference on operative time. It revealed stone volume to be the most significant predictor of operative time. Thus, the present study provides valuable information regarding the factors influencing operating time during retrograde intrarenal surgery for renal stone.

Comparison and Evaluation of Outcomes of Ureteroscopy and Stone Laser Fragmentation in Extremes of Age Groups (≤10 Years and ≥80 Years of Age): A Retrospective Comparative Analysis of over 15 Years from 2 Tertiary European Centres

To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year period (group 1). It was compared to consecutive data for all patients ≥80 years (group 2). Data were collected for patient demographics, stone characteristics, operative details, and clinical outcomes. A total of 168 patients had 201 URSL procedures during this time (74 and 94 patients in groups 1 and 2 respectively). The mean age and stone sizes were 6.1 years and 85 years, and 9.7 mm and 13 mm for groups 1 and 2 respectively. While the SFR was slightly higher in group 2 (92.5% versus 87.8%, p = 0.301), post-operative stent rate was also significantly higher in the geriatric population (75.9% versus 41.2%, p = 0.0001). There was also no significant difference in pre-operative stenting (p = 0.886), ureteric access sheath use (UAS) (p = 0.220) and post-operative complications. Group 1 had an intervention rate of 1.3/patient as compared to 1.1/patient in group 2. The overall complications were 7.2% and 15.3% in groups 1 and 2 respectively (0.069), with 1 Clavien IV complication related to post-operative sepsis and brief ICU admission in group 2. The paediatric population had a marginally higher incidence of repeat procedure, but the overall SFR and complications were similar, and post-operative stent insertion rates were much better compared to geriatric patients. URSL is a safe procedure in the extremes of age groups with no difference in the overall outcomes between the two groups.

A single center comparative study of two single use digital flexible ureteroscopy in the management of renal stones less than 2 cm

PurposeFor renal stones < 2 cm, guidelines recommend the use of retrograde intrarenal surgery as a first line treatment option. Many available single use flexible ureteroscopy were found. We aim to compare the effectiveness of two single use flexible ureteroscopy; Pusen Uscope 3011 versus LithoVue in the management of renal stones less than 2 cm.MethodsOur study prospectively included 60 patients equally divided in to two groups: Pusen group and LithoVue group during the period from June 2020 to June 2021. The included patients were above 18 years old. Perioperative details as operative time, fluoroscopy time, hospital stay, and complications were recorded. Stone free rate was assessed. Base purchase cost was also compared.ResultsThere was no statistically significant difference between the two groups regarding age, gender, and body mass index (BMI), stones size, side, number and location. The perioperative evaluation and outcome had no statistically significant differences between the two groups regarding the operative time, hospital stay, access sheath use, and stone free rate or radiation exposure. Among all cases, we had 49 cases (81.6%) with no postoperative complications (21 cases for Pusen group and 28 cases for LithoVue group). The incidence of postoperative complications was significantly higher among Pusen group than LithoVue group (p = 0.02). Initial purchase cost for both FURS had no significant difference (P = 0.86).ConclusionRIRS can be performed effectively with Pusen 3011 and LithoVue single use flexible ureteroscopy in patients diagnosed with renal calculi < 2 cm with superior outcomes with LithoVue.

Clinical Comparison between Three Single-Use Flexible Ureteroscope Models: A Real-World Experience

Introduction: Studies comparing different single-use flexible ureteroscope (su-fURS) models are lacking. The objective was to compare three types of su-fURS: the Uscope 3022 (PUSEN), LithoVue (Boston Scientific), and EU-scope (Innovex). Methods: This was a retrospective study comparing the clinical outcomes from patients undergoing flexible ureteroscopy with one of the three su-fURS for upper urinary tract stone treatment between September 2019 and 2021. Analysis included total surgery and fluoroscopy time, post-procedure ureteral catheter, stone-free rate (SFR), and complications. Results: There were 104 cases with the Uscope 3022, 141 with LithoVue, and 80 with EU-scope. Groups were comparable in terms of stone size, location and density, and prior double-J stent presence. Multivariate analysis showed no difference in terms of SFR: 79% (Uscope 3022), 77.5% (LithoVue), and 81% (EU-scope); p = 0.38. Significant differences were found for total surgery and fluoroscopy time, as well as ureteral access sheath use (p < 0.001), favoring the EU-scope group. Discussion/Conclusion: The three devices evaluated are highly effective in treatment of kidney stones. Reasons for difference in total surgery and fluoroscopy time and access sheath use are not clear. However, this could be explained by technical aspects of these devices, such as external diameter, optical resolution, and field of view.

Impact of ureteral access sheath use on outcomes of flexible ureteroscopy for renal stones

Introduction and objective: Improvements in endoscopic technologies have led to an expansion of flexible ureteroscopy indications in the treatment of renal and ureteral stones. Ureteral access sheath (UAS) was introduced in the clinical practice to facilitate endoscopic access into the upper urinary tract, reduce intrarenal pressure during the procedure and allow the extraction of fragments. The objective of this study is to analyze the impact of UAS on the efficacy and safety of flexible ureteroscopy (fURS) for the treatment of renal stones. Material and methods: a prospectively collected database including 251 consecutive patients treated with fURS between January 2018 and November 2022 was analyzed. Patients were divided into two groups: group 1 – without UAS, 21 patients (8.3%) and group 2 – with UAS, 231 patients (91.7%). UAS was used at the surgeon’s discretion and 3 patients (1.2%) underwent a sheathless procedure due to failure of UAS insertion. Data on patients’ preoperative characteristics and fURS efficacy and safety were compared. Results: There were no statistically significant differences in patients’ preoperative characteristics except for stone size and surface, which were significantly larger in group 2 (9.6±4.1 vs 13.8±5.2 mm; р&lt;0.001 and 68.6±74.2 vs 128.3±109.3 mm2, p=0.002, respectively). Operating time was significantly longer in group 2 (33.6±12.9 vs 42.0±12.9 min, p=0.005). Stone-free rate after a single procedure and at 3rd postoperative month was similar between groups (95.2% vs 87%, p=0.486 and 95.2% vs 88.7%, p=0.709, respectively). The intra- and postoperative complication rates were higher for group 1 (4.8% vs 0.8%, р=0.011 and 14.3% vs 12.1%, p=0.062, respectively). Multivariate regression model identified stone surface (р&lt;0.001), number of stones (p=0.005) and calcium oxalate monohydrate stone composition (р=0.005), but not UAS use (p=0.580), as independent predictors for stone-free rate following fURS. Conclusions: The results of this study suggest that UAS use has no impact on the efficacy of fURS and is not associated with an increased rate of intra- and postoperative complications.

Cost Comparison: Evaluating Transfemoral and Transradial Access for Diagnostic Cerebral Angiography.

Modern medicine necessitates the delivery of increasingly complex health care while minimizing cost. Transradial access (TRA) for neuroendovascular procedures is becoming more common as accumulating data demonstrate fewer complications, improved patient satisfaction, and high rates of treatment success compared with the transfemoral access (TFA) approach; however, disparities in cost between these approaches remain unclear. We compared supply and equipment costs between TRA and TFA for diagnostic cerebral angiography and evaluate the specific items that account for these differences. We reviewed all adult patients who underwent diagnostic cerebral angiography from July 1, 2019 to December 31, 2019. Data related to patient demographics, vascular access site, catheters used, cost of catheters, arterial access sheath use, cost of sheaths, closure devices used, and cost of closure devices were collected. The transradial approach resulted in higher price of radial access sheath; however, the overall cost of closure devices was much lower in TRA group than in the TFA cohort. There was no significant difference in the cost of catheters. Overall, the total supply costs for TRA cerebral angiography were significantly lower than those of TFA cerebral angiography. The relative materials cost difference of using TRA was 20.9%. This study is the first itemized materials cost analysis of TRA versus TFA cerebral angiography. TRA necessitates the use of a more expensive access sheath device; however, this cost is offset by the increased cost of devices used for femoral arteriotomy closure. Overall, the supply and equipment costs were significantly lower for TRA than TFA.

Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings.

PurposeProlonged ureteroscopy (URS) is associated with complications including ureteral perforation, stricture, and urosepsis. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. This retrospective study was designed to determine if Thulium fiber laser (TFL) lithotripsy decreases operative time and costs compared to standard Holmium:YAG (Ho:YAG) lithotripsy without pulse modulation.MethodsA retrospective review of URS with laser lithotripsy was conducted for 152 cases performed from August 2020 to January 2021. Variables including cumulative stone size, location, chemical composition, prior ureteral stenting, and ureteral access sheath use were recorded for each case. A cost benefit analysis was performed to show projected cost savings due to potentially decreased operative times.ResultsCompared to Ho:YAG, use of TFL resulted in an average decrease of 12.9 min per case (p = .021, 95% CI [2.03–23.85]). In subgroup analysis of cases with cumulative stone diameter less than 15 mm, the difference was 14.0 min (p = .007, CI [3.95–23.95]). For cases less than 10 mm, the mean difference was 17.3 min in favor of TFL (p = .002, 95% CI [6.89–27.62]). This ~ 13 min reduction in operative time resulted in saving $440/case in direct operating room costs giving our institution a range of $294,000 to $381,900 savings per year.ConclusionsTFL has a significantly shorter operative time and decreased cost when compared to the standard Ho:YAG for equivalent kidney stone and patient characteristics. Longer term follow up is needed to see if recurrence rates are affected.

Standardizing Perioperative Medications to Be Used in an Enhanced Recovery After Surgery Program Is Feasible in Percutaneous Nephrolithotomy Patients.

Introduction: The objective of this process improvement project was to determine the effect of enhanced recovery after surgery (ERAS) protocol for percutaneous nephrolithotomy (PCNL) patients with respect to quality of life (QOL) and pain management in the postoperative recovery period. Methods: An electronic-based medical record ERAS orders protocol for PCNL was instituted at an academic medical center in July 2020. The protocol utilized a pain control regimen designed to minimize opioid medication use postoperatively. We prospectively evaluated PCNL patients' QOL through the Wisconsin Stone Quality of Life (WISQOL) survey and Patient-Reported Outcomes Measurement System (PROMIS) at routine perioperative visits. To assess any opioid reduction benefit of the ERAS protocol, we reviewed an age-matched historical cohort n = 66 (before ERAS implementation) to serve as a comparison cohort with respect to opioid usage. Results: After an inception cohort of 95 patients, 55 ERAS patients remained available for assessment with the WISQOL and PROMIS surveys. In comparison with the non-ERAS cohort, the ERAS cohort represented larger stones, more supine positioning, higher blood loss, shorter hospital stay, and more use of access sheath. ERAS patients received a significantly lower amount of opioids compared with non-ERAS patients upon discharge narcotic usage (116.13 morphine milliequivalent [MME] vs 39.57 MME, p = 0.0001). Compared with their preoperative evaluation, the ERAS cohort had significantly improved QOL scores at 1 week, which sustained through 8 weeks postoperatively. Moreover, pain intensity and pain interference scores were improved at 8 weeks postoperatively for ERAS patients compared with their preoperative time point. Conclusions: We demonstrate that standardizing medications in early efforts toward a PCNL ERAS protocol is feasible and allows for reduced opioid use by patients while achieving early and sustained postprocedure QOL.

MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS

You have accessJournal of UrologyCME1 May 2022MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS Daniel Wong, and Alana Desai Daniel WongDaniel Wong More articles by this author , and Alana DesaiAlana Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vacuum assisted ureteral access sheaths (V-UAS) have been eagerly adopted with the hopes of improved surgical outcomes. Reports from outside the US have found increased stone free rates, decreased operative times, and decreased infectious complications with V-UAS. However there have been no data published from the US. Herein, we report our findings 1 year after implementation of Clearpetra V-UAS at our institution. METHODS: From May 2020 to September 2021, all unilateral ureteroscopy cases by a single surgeon using a V-UAS (Clearpetra) were retrospectively reviewed. These were compared to matched cases using an institutional database of stone cases from 2016 to May 2020, when Clearpetra became available. Cases were matched based on regular ureteral access sheath use, surgeon, stone burden, preexisting ureteral stent, preoperative UTI, and neurogenic bladder. Outcomes of interest were stone free rate as determined by follow up ultrasound or CT scan within 3 months of procedure and postop infection defined by T >38°C, WBC >12K or <4K, HR >90, or UTI within 30 days of procedure. RESULTS: There were 27 unique V-UAS cases identified. Randomly matched cases were compared for operative time, stone free rate, infectious complications, and 30-day unplanned encounters. There were no differences in any outcomes of interest (Figure 1). CONCLUSIONS: V-UAS performed on par with standard ureteral access sheaths. There was no increase in complication rate or unplanned encounters, indicating V-UAS is a safe treatment option. V-UAS offered no benefit in terms of operative time, stone free rate, or infectious complications in this initial cohort. It remains to be seen whether there is an optimal stone characteristic for V-UAS or whether V-UAS requires an initial learning curve for improvement. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e758 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Alana Desai More articles by this author Expand All Advertisement PDF DownloadLoading ...