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C162: Routine use of ureteral access sheath during retrograde flexible ureteroscopy
C162: Routine use of ureteral access sheath during retrograde flexible ureteroscopy Multescu R., Geavlete P., Dragutescu M., Georgescu D., Nita G., Satalan R., Geavlete B. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania INTRODUCTION & OBJECTIVES: Use of ureteral access sheath (UAS) during retrograde flexible ureteroscopy is still an issue of debate. The aim of our study was to evaluate the particularities of routine use of such a device.
MATERIAL & METHODS: We prospectively evaluated 200 patients treated by retrograde flexible ureteroscopic approach for single pyelocaliceal stones between 1 and 2 cm in size: 100 in which a Cook Flexor 10/12F ureteral access sheath was used and 100 in which the procedure was performed without it. Pre-ureteroscopy stenting necessities, intraprocedural characteristics, stone-free rates and complications were evaluated and compared.
RESULTS: 7% of the first group and 10% of the second one were already JJ stented. Due to difficulties to ascend the UAS a supplementary 8% of the cases from the study group were also stented, while in the second group impossible ureteral passage of the flexible ureteroscope imposed this maneuver in 2% of the cases. Intraprocedural visibility was better when the UAS was used (mean score 4.5 vs. 3.9). Perioperative complications rate and stone free rate were similar among the two groups (13% vs. 9% and 96% vs. 97% respectively). Septic complications were significantly reduced in the study group (30% vs. 55.5%). No late ureteral stenosis was encountered.
CONCLUSIONS: Routine but careful use of ureteral access sheath does not increase the complication’ rates specific for the flexible ureteroscopic approach. It offers some clear advantages regarding access, visibility and seems to be associated with less septic complications, probably by maintaining a low pressure.
Eur Urol Suppl 2014; 13(6) e1342
MATERIAL & METHODS: We prospectively evaluated 200 patients treated by retrograde flexible ureteroscopic approach for single pyelocaliceal stones between 1 and 2 cm in size: 100 in which a Cook Flexor 10/12F ureteral access sheath was used and 100 in which the procedure was performed without it. Pre-ureteroscopy stenting necessities, intraprocedural characteristics, stone-free rates and complications were evaluated and compared.
RESULTS: 7% of the first group and 10% of the second one were already JJ stented. Due to difficulties to ascend the UAS a supplementary 8% of the cases from the study group were also stented, while in the second group impossible ureteral passage of the flexible ureteroscope imposed this maneuver in 2% of the cases. Intraprocedural visibility was better when the UAS was used (mean score 4.5 vs. 3.9). Perioperative complications rate and stone free rate were similar among the two groups (13% vs. 9% and 96% vs. 97% respectively). Septic complications were significantly reduced in the study group (30% vs. 55.5%). No late ureteral stenosis was encountered.
CONCLUSIONS: Routine but careful use of ureteral access sheath does not increase the complication’ rates specific for the flexible ureteroscopic approach. It offers some clear advantages regarding access, visibility and seems to be associated with less septic complications, probably by maintaining a low pressure.
Eur Urol Suppl 2014; 13(6) e1342