Skip to main content
Top
Published in: World Journal of Urology 1/2014

01-02-2014 | Original Article

The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones

Authors: Gaetan Berquet, Paul Prunel, Grégory Verhoest, Romain Mathieu, Karim Bensalah

Published in: World Journal of Urology | Issue 1/2014

Login to get access

Abstract

Purpose

To evaluate the impact of a ureteral access sheath (UAS) on stone-free (SF) rate after flexible ureteroscopy for upper urinary tract stones.

Materials and methods

We retrospectively reviewed 280 patients who underwent flexible ureteroscopy (URS) for upper urinary tract stone between 2009 and 2012. Patients were divided into two groups based on whether a UAS was used (n = 157) or not (n = 123). SF rate was evaluated at one and three months after surgery by abdominal imaging. Quantitative and qualitative variables were compared with Student’s t test and χ2 test, respectively. A logistic regression model was used to determine the predictive factors of SF status.

Results

Stone size was similar in both groups (15.1 vs. 13.7 mm, p = 0.21). SF rates at one and 3 months were comparable in UAS and non-UAS groups (76 vs. 78 % and 86 vs. 87 %, p = 0.88 and 0.89, respectively). Complication rates were similar in both groups (12.7 vs. 12.1 %, p = 0.78). In multivariable analysis, stone size was the only predictive factor of SF rate (p = 0.016).

Conclusion

The routine use of a UAS did not improve SF rate in patients undergoing flexible URS for upper urinary tract calculi.
Literature
1.
go back to reference Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21:119–123PubMedCrossRef Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21:119–123PubMedCrossRef
2.
go back to reference Vanlangendonck R, Landman J (2004) Ureteral access strategies: pro-access sheath. Urol Clin North Am 31:71–81PubMedCrossRef Vanlangendonck R, Landman J (2004) Ureteral access strategies: pro-access sheath. Urol Clin North Am 31:71–81PubMedCrossRef
3.
go back to reference Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718PubMedCrossRef Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718PubMedCrossRef
4.
go back to reference Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165:789–793PubMedCrossRef Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165:789–793PubMedCrossRef
5.
go back to reference Auge BK, Pietrow PK, Lallas CD et al (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36PubMedCrossRef Auge BK, Pietrow PK, Lallas CD et al (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36PubMedCrossRef
6.
go back to reference L’Esperance JO, Ekeruo WO, Scales CD Jr et al (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255PubMedCrossRef L’Esperance JO, Ekeruo WO, Scales CD Jr et al (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255PubMedCrossRef
7.
go back to reference Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584PubMedCrossRef Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584PubMedCrossRef
8.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef
9.
go back to reference Wignall GR, Canales BK, Denstedt JD et al (2008) Minimally invasive approaches to upper urinary tract urolithiasis. Urol Clin North Am 35:441–454PubMedCrossRef Wignall GR, Canales BK, Denstedt JD et al (2008) Minimally invasive approaches to upper urinary tract urolithiasis. Urol Clin North Am 35:441–454PubMedCrossRef
10.
go back to reference Chow GK, Patterson DE, Blute ML (2003) JW: Ureteroscopy: effect of technology and technique on clinical practice. J Urol 170:99–102PubMedCrossRef Chow GK, Patterson DE, Blute ML (2003) JW: Ureteroscopy: effect of technology and technique on clinical practice. J Urol 170:99–102PubMedCrossRef
11.
go back to reference Wendt-Nordahl G, Mut T, Krombach P et al (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39:185–188PubMedCrossRef Wendt-Nordahl G, Mut T, Krombach P et al (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39:185–188PubMedCrossRef
12.
go back to reference Breda A, Ogunyemi O, Leppert JT et al (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196PubMedCrossRef Breda A, Ogunyemi O, Leppert JT et al (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196PubMedCrossRef
13.
go back to reference Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108–111PubMedCrossRef Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108–111PubMedCrossRef
14.
go back to reference Srisubat A, Potisat S, Lojanapiwat B, et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044 Srisubat A, Potisat S, Lojanapiwat B, et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044
15.
go back to reference Takayasu H, Aso Y (1974) Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol 112:176–178PubMed Takayasu H, Aso Y (1974) Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol 112:176–178PubMed
16.
go back to reference Aboumarzouk OM, Monga M, Kata SG, et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26(10):1257–1263 Aboumarzouk OM, Monga M, Kata SG, et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26(10):1257–1263
17.
go back to reference Aboumarzouk OM, Somani B and Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110(8 Part B):E374–380 Aboumarzouk OM, Somani B and Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110(8 Part B):E374–380
18.
go back to reference Sofer M, Watterson JD, Wollin TA et al (2002) Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31–34PubMedCrossRef Sofer M, Watterson JD, Wollin TA et al (2002) Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31–34PubMedCrossRef
19.
go back to reference Hyams ES, Bruhn A, Lipkin M et al (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24:1411–1414PubMedCrossRef Hyams ES, Bruhn A, Lipkin M et al (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24:1411–1414PubMedCrossRef
20.
go back to reference Rebuck DA, Macejko A, Bhalani V et al (2011) The natural history of renal stone fragments following ureteroscopy. Urology 77:564–568PubMedCrossRef Rebuck DA, Macejko A, Bhalani V et al (2011) The natural history of renal stone fragments following ureteroscopy. Urology 77:564–568PubMedCrossRef
21.
go back to reference El-Nahas AR, El-Assmy AM, Madbouly K et al (2006) Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. J Endourol 20:870–874PubMedCrossRef El-Nahas AR, El-Assmy AM, Madbouly K et al (2006) Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. J Endourol 20:870–874PubMedCrossRef
22.
go back to reference Buchholz NP, Meier-Padel S, Rutishauser G (1997) Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation? J Endourol 11:227–232PubMedCrossRef Buchholz NP, Meier-Padel S, Rutishauser G (1997) Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation? J Endourol 11:227–232PubMedCrossRef
23.
go back to reference Kang DE, Maloney MM, Haleblian GE et al (2007) Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol. 177:1785–1788 discussion 1788–1789PubMedCrossRef Kang DE, Maloney MM, Haleblian GE et al (2007) Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol. 177:1785–1788 discussion 1788–1789PubMedCrossRef
24.
go back to reference Abrahams HM, Stoller ML (2004) The argument against the routine use of ureteral access sheaths. Urol Clin North Am 31:83–87PubMedCrossRef Abrahams HM, Stoller ML (2004) The argument against the routine use of ureteral access sheaths. Urol Clin North Am 31:83–87PubMedCrossRef
25.
go back to reference Lallas CD, Auge BK, Raj GV et al (2002) Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol 16:583–590PubMedCrossRef Lallas CD, Auge BK, Raj GV et al (2002) Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol 16:583–590PubMedCrossRef
26.
go back to reference Delvecchio FC, Auge BK, Brizuela RM et al (2003) Assessment of stricture formation with the ureteral access sheath. Urology. 61:518–522 discussion 522PubMedCrossRef Delvecchio FC, Auge BK, Brizuela RM et al (2003) Assessment of stricture formation with the ureteral access sheath. Urology. 61:518–522 discussion 522PubMedCrossRef
Metadata
Title
The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones
Authors
Gaetan Berquet
Paul Prunel
Grégory Verhoest
Romain Mathieu
Karim Bensalah
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 1/2014
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-013-1181-5

Other articles of this Issue 1/2014

World Journal of Urology 1/2014 Go to the issue