You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-09 IS PROLONGED USE OF URETERAL ACCESS SHEATH SAFE? Husain Alenezi, Christopher J. Howlett, Alexander O. El-Warrak, Daniel Olvera-Posada, Marie Dion, Hassan Razvi, and John D. Denstedt Husain AleneziHusain Alenezi More articles by this author , Christopher J. HowlettChristopher J. Howlett More articles by this author , Alexander O. El-WarrakAlexander O. El-Warrak More articles by this author , Daniel Olvera-PosadaDaniel Olvera-Posada More articles by this author , Marie DionMarie Dion More articles by this author , Hassan RazviHassan Razvi More articles by this author , and John D. DenstedtJohn D. Denstedt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1748AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureteroscopy (fURS) utilization in the treatment of large and complex upper tract urolithiasis is rising, leading to longer operative times. Ureteral access sheath (UAS) is a widely used ancillary instrument during fURS. UAS can be associated with direct trauma to the ureter together with decreased blood supply due to compression of the ureteral wall. The safety of using UAS for more than 70 minutes is unknown. Our objective is to study the long-term effects of the prolonged use of UAS in an animal model. METHODS Twenty-two female farm pigs (weight 25- 30 kg) with a total of 44 ureters were subjected to an endoscopic procedure under general anesthesia, starting with bilateral retrograde pyelography (RGP) to exclude preexisting ureteral abnormality, followed by insertion of 35 cm 12/14 Fr UAS for 1 hour in one ureter (group 1) then for 3 hours into the contralateral ureter (group 2). Random allocation of the ureters into the groups was performed preoperatively. A single operator performed all procedures and the perceived resistance to UAS insertion was noted. After 4 weeks, bilateral RGP was performed followed by harvesting bilateral ureters, kidneys and bladder and finally euthanasia. Assessment of the RGP and gross pathological appearance of the ureters was performed to identify any ureteral stricture. RESULTS Eighteen animals survived to trial completion (36 ureters). Ureteral stricture was evident in 1 ureter (5.5%) and 5 ureters (27.7%), in groups 1 (1hr) and 2 (3hr) respectively (p= 0.177). However the strictured ureter in group 1 was found to be part of a duplex system on cross-sectioning, thus the difference in stricture rate becomes significant (p= 0.044, OR 1.417, CI 95% 1.042-1.925) when that ureter is excluded. Most of the strictures involved the lower third of ureters (n=5) and the remaining one involved the middle third of the ureter. No resistance was encountered during UAS insertion in 14 ureters (38.9%), while mild and moderate resistance were encountered in 20 ureters (55.6%) and 2 ureters (5.6%), respectively. The likelihood ratio of ureteral stricture was 7.174 with increasing resistance (p=0.028). In univariate analysis, resistance to UAS was the only significant predictor of stricture formation (p=0.049, OR 8.9, CI 95% 1.01-78.47). CONCLUSIONS In this study, the prolonged indwelling time of UAS was associated with increased rate of ureteral strictures, while resistance to UAS insertion was a predictor of increased risk of ureteral strictures. Therefore, we recommend limiting the time of UAS use and avoiding UAS insertion if any resistance is encountered. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e509 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Husain Alenezi More articles by this author Christopher J. Howlett More articles by this author Alexander O. El-Warrak More articles by this author Daniel Olvera-Posada More articles by this author Marie Dion More articles by this author Hassan Razvi More articles by this author John D. Denstedt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...