TY  - JOUR
T1  - ÜRETERAL ACCESS SHEATH KULLANILMADAN UYGULANAN RIRC TEDAVİSİNDE ETKİNLİK VE POSTOPERATİF ÜRİNER SİSTEM ENFEKSİYONU GELİŞİMİNİN DEĞERLENDİRİLMESİ
TT  - Evaluation of The Effectiveness and Postoperative Urinary Tract Infection Development in RIRS Treatment Performed Without The Use of A Ureteral ‘Access Sheath’
AU  - Eren, Berkay
AU  - Sarıcı, Haşmet
AU  - Gercek, Osman
AU  - Uzun, Recep
AU  - Ulucak, M. Ali
PY  - 2025
DA  - September
Y2  - 2024
JF  - Bozok Tıp Dergisi
PB  - Yozgat Bozok University
WT  - DergiPark
SN  - 2146-4006
SP  - 240
EP  - 248
VL  - 15
IS  - 3
LA  - tr
AB  - Amaç: Biz bu çalışmamızda böbrek taşları nedeni ile ‘Access Sheath’ kullanılmadan Retrograd İntrarenalCerrahi (RIRC) uyguladığımız hastalarda, taşın böbrekteki yerleşim yeri ile taşın boyutu, preoperatif DoubleJ Stent (DJS) varlığı ve preoperatif pozitif idrar kültürü varlığının postoperatif erken dönem enfeksiyon gelişimine etkisini ve taşın böbrekteki yerleşim yeri ile taşın boyutu ve Hounsfield Unit (HU) değerinin taşsızlıkoranlarına etkisini karşılaştırmayı amaçladık.Gereç ve Yöntemler: Bu retrospektif çalışma Ocak 2021 – Mart 2024 tarihleri arasında böbrek taşı nedeniile ‘Access Sheath’ kullanılmadan RIRC + Laser Litotripsi uyguladığımız ve DJ Stent yerleştirilen 326 hastaüzerinde yapılmıştır. Hastaların Re-Do Retrograd Intrarenal Cerrahi (Re-RIRC) gereksinimi, postoperatif erkendönem enfeksiyon gelişimi ve postoperatif 4. Haftada renal taşsızlık durumları incelenmiştir.Bulgular: Bu çalışmada postoperatif enfeksiyon gelişen ve gelişmeyen hastalar iki farklı grup olarak incelendiğinde; gruplar arasında, yaş, cinsiyet, taş hacmi, taş lokalizasyonu ve operasyon süresi açısından istatistiksel anlamlı fark saptanmadı (sırasıyla; p=0,968, p=0,346, p=0,318, p=0,151, 0,621). Postoperatif enfeksiyongelişen grupta 19 (%35,2) hastada preoperatif DJS takıldığı izlendi ve bu oran enfeksiyon gelişmeyen grubagöre anlamlı olarak yüksekti (p=0,002). Ayrıca postoperatif enfeksiyon gelişen grupta, gelişmeyen grubagöre anlamlı derecede yüksek rezidü taş varlığı saptandı (p<0,001). Rezidü taş saptanan grupta alt pol vemultipl taş varlığının diğer gruba göre anlamlı olarak yüksek olduğu görüldü (p=0,016).Sonuç: Böbrek taşlarının RIRC ile tedavisinde rutin olarak Üreteral ‘Access Sheath’ kullanımı her zamangerekli değildir. Üreteral ‘Access Sheath’ kullanılmadan uygulanan cerrahilerin başarısı, taşsızlık oranları, taşın HU değeri ve taş hacmi ile ilişkilidir. Ayrıca ‘Access Sheath’ kullanılarak yapılan cerrahilerde görülen üreteral yaralanmalar uyguladığımız hiçbir cerrahide görülmemiştir ve operasyon süresi daha kısadır.
KW  - Üreteral ‘Access Sheat’
KW  - RIRC
KW  - Üriner Sistem Enfeksiyonu
KW  - Rezidüel Taş Varlığı
N2  - Aim: This study aims to evaluate the effects of stone location and size, the presence of a preoperative DJ stent, and preoperative positive urine culture on early postoperative infection in patients undergoing RIRS without the use of an access sheath due to kidney stones. Additionally, we aim to compare the effects of stone location, size, and Hounsfield Unit (HU) value on stone-free rates.Materials and Methods: This retrospective study was conducted on 326 patients who underwent RIRS + Laser Lithotripsy without the use of an access sheath, followed by DJ-stent placement, between January 2021 and March 2024. Postoperative infection, the need for re-RIRS, and stone-free status at 4 weeks postoperatively were analyzed.Results: When comparing patients with and without postoperative infections, there was no statistically significant difference between the groups in terms of age, gender, stone volume, stone location or operation time (p=0.968, p=0.346, p=0.318, p=0.151, p=0.621, respectively). Preoperative DJ stent placement was significantly higher in the infection group (35.2% vs. non-infection group, p=0.002). Residual stones were also significantly more common in the infection group (p<0.001), with a higher incidence of lower pole and multiple stones (p=0.016).Conclusion: Routine use of a ureteral access sheath is not always necessary for RIRS in kidney stone treatment. Success and stone-free rates are related to stone size, location, and HU value. Additionally, no ureteral injuries were observed, and the operation time was shorter without an access sheath.
CR  - 1. Romero V., Akpinar H., Assimos D.G. Kidney stones: A global
picture of prevalence, incidence, and associated risk factors. Rev.
Urol. 2010;12:e86–e96.
CR  - 2. Cauni V., Mihai B., Tănase F., Perşu C., Ciofu I. Application of laser
technology in urinary stone treatment. 2022;67:85–9.
CR  - 3. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris
A, Liatsikos E, et al. Trends of ‘‘urolithiasis: interventions, simulation, and laser technology’’ over the last 16 years (2000---2015)
as published in the literature (PubMed): a systematic review
from European section of Uro-technology (ESUT). World J Urol.
2017;35:1651-8.
CR  - 4. Lin C-B, Chuang S-H, Shih H-J, Pan Y. Utilization of Ureteral Access
Sheath in Retrograde Intrarenal Surgery: A Systematic Review and
Meta-Analysis. Medicina. 2024; 60(7):1084.
CR  - 5. Takayasu, H.; Aso, Y. Recent Development for Pyeloureteroscopy:
Guide Tube Method for Its Introduction into the Ureter. J Urol.
1974;112(2):176-8.
CR  - 6. Kourambas J, Byrne RR, Preminger GM. Does a ureteral Access
sheath facilitate ureteroscopy? J Urol. 2001;165:789-93.
CR  - 7. L’esperance JO, Ekeruo WO, Scales CD, Marguet CG,
PatrickSpringhart W, Maloney ME, et al. Effect of ureteral access
sheathon stone-free rates in patients undergoing ureteroscopic
management of renal calculi. Urology. 2005;66:252-5.
CR  - 8. Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral Access Sheath Provides Protection against
Elevated Renal Pressures during Routine Flexible Ureteroscopic
StoneManipulation. J Endourol. 2004;18:33-6.
9. Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC,
et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61:713-8.
CR  - 10. Türk C, Petrík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al.EAU
Guidelines on Interventional Treatment for Urolithiasis. Eur Urol.
2016;69:475-82
CR  - 11. Assimos D, Krambeck A, Miller NL, Monga M, Hassan Murad
M,Nelson CP, et al. Surgical Management of Stones: American Urological. Association/Endourological Society Guideline, PART I. J Urol.
2016;196:1153-60.
CR  - 12. Huang J, Zhao Z, AlSmadi JK, Liang X, Zhong F, Zeng T, et al., Use of
the ureteral access sheath during ureteroscopy: A systematic review
and meta-analysis. PLoS One. 2018;28;13;2:e0193600
CR  - 13. Stern JM, Yiee J, Park S. Safety And Efficacy of Ureteral
AccessSheaths. J Endourol. 2007;21(2):119-23.
CR  - 14. Breda A, Territo A, López-Martínez JM. Benefits and risks of
ureteral access sheaths for retrograde renal access. Curr Opin Urol.
2016;26(1):70-5.
CR  - 15. Özsoy M, Kyriazis I, Vrettos T, Kotsiris D, Ntasiotis P, Seitz C,et al.
Histological changes caused by the prolonged placement of ureteral
access sheaths: an experimental study in porcine model. Urolithiasis.
2018;46(4):397-404.
CR  - 16. Lildal SK, Andreassen KH, Jung H, Pedersen MR, Osther PJS.
Evaluation of ureteral lesions in ureterorenoscopy: impact of access
sheath use. Scand J Urol. 2018;52(2):157-61.
CR  - 17. Cybulski P, John D’A, Honey R, Pace K. Fluid Absorption during
Ureterorenoscopy. J Endourol. 2004;18(8):739-42.
CR  - 18. Traxer O, Wendt-Nordahl G, Sodha H, Rassweiler J, Meretyk
S,Tefekli A, et al. Differences in renal stone treatment and out-comes
for patients treated either with or without the supportof a ureteral
access sheath: The Clinical Research Office of theEndourological
Society Ureteroscopy Global Study. World J Urol.2015;33(12):2137-
44.
CR  - 19. Cristallo C, Santillán D, Tobia I, Tirapegui FI, Daels FP, González
MS. Flexible ureteroscopy without ureteral access sheath. Actas Urol
Esp (Engl Ed). 2022;46(6):354-60.
CR  - 20. Berquet G, Prunel P, Verhoest G, Mathieu R, Bensalah K. Theuse
of a ureteral access sheath does not improve stone-free rate
after ureteroscopy for upper urinary tract stones. World J Urol.
2014;32(1):229-32.
CR  - 21. Traxer O, Dubosq F, Jamali K, Gattegno B, Thibault P. Newgeneration flexible ureterorenoscopes are more durable than
previous ones. Urology. 2006;68(2):276-9.
CR  - 22. Pietrow PK, Auge BK, Delvecchio FC, Silverstein AD, Weizer AZ,
Albala DM, et al. Techniques to maximize flexible ureteroscope
longevity. Urology. 2002;60(5):784-8.
CR  - 23. Multescu R, Geavlete B, Georgescu D, Geavlete P. Improved
Durability of Flex-Xc Digital Flexible Ureteroscope: How Long Can You
Expect It to Last? Urology. 2014;84(1):32-5.
CR  - 24. Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser Doppler Flowmetric Determination of
Ureteral Blood Flow after Ureteral Access Sheath Placement. J
Endourol.2002;16(8):583-90.
CR  - 25. Torricelli FC, De S, Hinck B, Noble M, Monga M.
Flexibleureteroscopy with a ureteral access sheath: when to
stent?Urology. 2014;83(2):278-81.
CR  - 26. Jiang P , Xie L , Arada R, Patel RM, Landman J , Clayman RV.
Qualitative Review of Clinical Guidelines for Medical and Surgical
Management of Urolithiasis: Consensus and Controversy 2020. J
Urol. 2021;205(4):999-1008.
UR  - https://dergipark.org.tr/en/pub/bozoktip/issue//1549356
L1  - https://dergipark.org.tr/en/download/article-file/4211224
ER  -