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Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?

Year 2023, Volume: 13 Issue: 1, 82 - 86, 26.04.2023

Ümit Yıldırım Mehmet Uslu Mehmet Ezer Bumin Ors

Abstract

Aim: Studies indicate that a ureteric access sheath (UAS) is unnecessary for retrograde intrarenal surgery 5 (RIRS) if the surgeon enters the ureter directly. This research aims to look back on our case series in light of the existing literature and directly compare cases with and without a UAS in terms of efficacy, safety, and stone-free rates in the late postoperative period (3rd month).
Materials and Methods: From January 2019 to June 2022, a retrospective screening of kidney stone cases treated with RIRS in our clinic was carried out. The study included one hundred fiftythree participants who complied with all inclusion and exclusion criteria. Group UAS was created for individuals who received UAS applications, and Group N for those who did not. The demographics, preoperative and postoperative laboratory, and radiographic data have been compared between the two groups.
Results: A comparable distribution in terms of gender and age (50.85±13.20 vs. 52.84±14.27; p=0, 476) was seen between the groups. The Charlson Comorbidity Indexes were found to have a similar distribution [median (IQR): 1 (0.5–2.5) vs. 1 (0–3); p=0.986]. Serum creatinine levels (0.92±0.27 vs. 0.97±0.34; p=0, 560), fever or sepsis (0.0% vs. 1.0%; p=0, 686), and hospital stay (2.15±0.65 vs. 2.31±0.74; p=0, 691) were comparable between the groups during the surgical follow-up. Even though Group UAS was superior in the postoperative three-month stone-free assessment with computerized tomography, this difference was not statistically significant (72.9% vs. 73.3%; p=0, 552).
Conclusion: In the surgical management of kidney stones, RIRS can be used safely and effectively whether or not UAS is used. Complications and success rates in the late postoperative phase (3 months) are not significantly impacted by UAS use.

Keywords

access sheath renal stones retrograde intrarenal surgery

References

  • 1. Romero V, Akpinar H, Assimos DG. Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors. Rev Urol. 2010;12(2–3):e86. doi:10.3909/riu0459.
  • 2. Chew BH, Lange D. The future of ureteroscopy. Minerva Urol Nefrol. 2016;68. (6):592–597. Accessed August 20, 2022. https://pubmed.ncbi.nlm.nih.gov/27759736/
  • 3. Ghani KR, Wolf JS. What is the stone-free rate following flexible ureteroscopy for kidney stones? Nature Reviews Urology 2015 12:5. 2015;12(5):281–288. doi:10.1038/nrurol.2015.74.
  • 4. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475–482. doi:10.1016/J.EURURO.2015.07.041.
  • 5. Chung DY, Kang DH, Cho KS, et al. Comparison of stonefree rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis. PLoS One. 2019;14(2). doi:10.1371/ JOURNAL.PONE.0211316.
  • 6. de Coninck V, Keller EX, Rodríguez-Monsalve M, Audouin M, Doizi S, Traxer O. Systematic review of ureteral access sheaths: facts and myths. BJU Int. 2018;122(6):959–969. doi:10.1111/ BJU.14389.
  • 7. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189(2):580–584. doi:10.1016/J.JURO.2012.08.197.
  • 8. Torricelli FC, De S, Hinck B, Noble M, Monga M. Flexible ureteroscopy with a ureteral access sheath: when to stent? Urology. 2014;83(2):278–281. doi:10.1016/J. UROLOGY.2013.10.002.
  • 9. Yitgin Y, Yitgin E, Verep S, Gasimov K, Tefik T, Karakose A. Is Access Sheath Essential for Safety and Effective Retrograde Intrarenal Stone Surgery? J Coll Physicians Surg Pak. 2021;31(10):1202–1206. doi:10.29271/JCPSP.2021.10.1202.
  • 10. Takayasu H, Aso Y. Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol. 1974;112(2):176–178. doi:10.1016/S0022-5347(17)59675-5.
  • 11. Auge BK, Pietrow PK, Lallas CD, Raj G v., Santa-Cruz RW, Preminger GM. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004;18(1):3336. doi:10.1089/089277904322836631.
  • 12. Noureldin YA, Kallidonis P, Ntasiotis P, Adamou C, Zazas E, Liatsikos EN. The Effect of Irrigation Power and Ureteral Access Sheath Diameter on the Maximal Intra-Pelvic Pressure During Ureteroscopy: In Vivo Experimental Study in a Live Anesthetized Pig. J Endourol. 2019;33(9):725–729. doi:10.1089/END.2019.0317.
  • 13. Berquet G, Prunel P, Verhoest G, Mathieu R, Bensalah K. The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World J Urol. 2014;32(1):229–232. doi:10.1007/S00345-013-1181-5.
  • 14. Traxer O, Wendt-Nordahl G, Sodha H, et al. Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. World J Urol. 2015;33(12):21372144. doi:10.1007/S00345-015-1582-8.
  • 15. Berquet G, Prunel P, Verhoest G, Mathieu R, Bensalah K. The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World J Urol. 2014;32(1):229–232. doi:10.1007/S00345-013-1181-5.
  • 16. Huang J, Zhao Z, AlSmadi JK, et al. Use of the ureteral access sheath during ureteroscopy: A systematic review and metaanalysis. PLoS One. 2018;13(2):e0193600. doi:10.1371/ JOURNAL.PONE.0193600.
  • 17. Cristallo C, Santillán D, Tobia I, Tirapegui FI, Daels FP, González MS. Flexible ureteroscopy without ureteral access sheath. Actas Urológicas Españolas (English Edition). 2022;46(6):354–360. doi:10.1016/J.ACUROE.2021.12.006.
  • 18. Yitgin Y, Yitgin E, Verep S, Gasimov K, Tefik T, Karakose A. Is Access Sheath Essential for Safety and Effective Retrograde Intrarenal Stone Surgery? J Coll Physicians Surg Pak. 2021;31(10):1202–1206. doi:10.29271/JCPSP.2021.10.1202.
  • 19. Acar C, Cal C. Impact of residual fragments following endourological treatments in renal stones. Adv Urol. Published online 2012. doi:10.1155/2012/813523.
  • 20. Ghani KR, Wolf JS. What is the stone-free rate following flexible ureteroscopy for kidney stones? Nature Reviews Urology 2015 12:5. 2015;12(5):281–288. doi:10.1038/nrurol.2015.74
There are 20 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Ümit Yıldırım This is me

Mehmet Uslu This is me

Mehmet Ezer This is me

Bumin Ors This is me

Publication Date April 26, 2023
Published in Issue Year 2023 Volume: 13 Issue: 1

Cite

APA Yıldırım, Ü., Uslu, M., Ezer, M., Ors, B. (2023). Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?. Kafkas Journal of Medical Sciences, 13(1), 82-86.
AMA Yıldırım Ü, Uslu M, Ezer M, Ors B. Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?. KAFKAS TIP BİL DERG. April 2023;13(1):82-86.
Chicago Yıldırım, Ümit, Mehmet Uslu, Mehmet Ezer, and Bumin Ors. “Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?”. Kafkas Journal of Medical Sciences 13, no. 1 (April 2023): 82-86.
EndNote Yıldırım Ü, Uslu M, Ezer M, Ors B (April 1, 2023) Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?. Kafkas Journal of Medical Sciences 13 1 82–86.
IEEE Ü. Yıldırım, M. Uslu, M. Ezer, and B. Ors, “Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?”, KAFKAS TIP BİL DERG, vol. 13, no. 1, pp. 82–86, 2023.
ISNAD Yıldırım, Ümit et al. “Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?”. Kafkas Journal of Medical Sciences 13/1 (April 2023), 82-86.
JAMA Yıldırım Ü, Uslu M, Ezer M, Ors B. Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?. KAFKAS TIP BİL DERG. 2023;13:82–86.
MLA Yıldırım, Ümit et al. “Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?”. Kafkas Journal of Medical Sciences, vol. 13, no. 1, 2023, pp. 82-86.
Vancouver Yıldırım Ü, Uslu M, Ezer M, Ors B. Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?. KAFKAS TIP BİL DERG. 2023;13(1):82-6.
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