You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-19 DIFFICULT URETERAL ACCESS IN CANDIDATES TO URETEROSCOPY FOR URINARY STONES: RESULTS AND TECHNICAL TRICKS ADOPTED IN A TERTIARY REFERRAL CENTRE Luca Villa, Eugenio Ventimiglia, Costantino Abbate, Pietro Dioni, Olivier Traxer, Alberto Briganti, Francesco Montorsi, and Andrea Salonia Luca VillaLuca Villa More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Pietro DioniPietro Dioni More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The miniaturization of surgical instruments along with the development of ancillary techniques have allowed to optimize the efficacy of endoscopic treatment of patients with urinary stones. However, anatomical characteristics may hamper the intra-operative access to the ureters. We aimed at investigating the rate of failed ureteral access in candidates to ureteroscopy (URS) for urinary stones. METHODS: We identified 383 candidates to URS for ureteral/renal stones from January 2015 to December 2020 at a single tertiary-referral centre. Pre-stented patients were excluded from the study cohort. The technique of ureteral access consisted of various steps according to the clinical scenario: 1)cannulation of the ureter with a hydrophilic guidewire; 2)for distal ureteral stone (below the iliac vessels): adoption of semi-rigid ureteroscope (rURS) (Wolf, 6/7.5 Ch) on a second working guidewire in the case of narrow ureteral orifices or co-axial to the safety guidewire in the case of compliant ureter; 3)for proximal ureteral stone (above the iliac vessels) and/or renal stone: use of flexible ureteroscope (fURS) (Flex-XC, Flex-X2s, URF-P5, URF-P6) on a second working guidewire in the case of narrow ureteral orifices or co-axial to the safety guidewire for compliant ureters (ureteral access sheath–10/12Fr- used only in the case of renal stones). In patients with not compliant ureters to the passage of endoscopic instruments, smooth ureteral dilation was attempted with 8/10Fr ureteral catheters. If the access was still impossible, an attempt with the smallest URS has been always done (namely, URF-P6-tip size 4.9Ch, shaft size 7.95Ch), regardless of the clinical scenario. Failed ureteral access was defined as the impossibility of ascending the ureter even with the smallest fURS, thus requiring the placement of Double-J and waiting two weeks for a passive ureteral dilation. Uni- and multivariate logistic regression analyses tested the role of patients’ characteristics on the risk of failed ureteral access. RESULTS: Of 237 non pre-stented candidates to URS, 14 (5.9%) patients required a Double-J stent placement for the impossibility of getting ureteral access. In this group, mean (IQR) age was 61 (53-73) years, 11 (78.6%) patients were males, 3 (21.4%) patients had a previous history of symptomatic urolithiasis and none had a previous history of any treatment for stones. At multivariate logistic regression analyses, a previous history of symptomatic stones was found to be a protective factor against the risk of failed ureteral access at URS (OR=0.07; 95% CI: 0.01-0.51; p=0.008). CONCLUSIONS: The miniaturization of the endoscopic instruments has not eliminated the risk of failed ureteral access in non pre- stented patients, which stands up to 6%. Candidates to URS should be aware of this possibility, especially in patients with the first stone event. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e325-e326 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Villa More articles by this author Eugenio Ventimiglia More articles by this author Costantino Abbate More articles by this author Pietro Dioni More articles by this author Olivier Traxer More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...