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World Journal of Urology
Published in: World Journal of Urology 5/2020

Open Access 01-05-2020 | Urosepticemia | Original Article

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

Authors: Ashleigh Lima, Thomas Reeves, Robert Geraghty, Amelia Pietropaolo, Lily Whitehurst, Bhaskar K. Somani

Published in: World Journal of Urology | Issue 5/2020

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Abstract

Purpose

To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period.

Methods

The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications.

Results

During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2–89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19).

Conclusion

The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
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Metadata
Title
Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period
Authors
Ashleigh Lima
Thomas Reeves
Robert Geraghty
Amelia Pietropaolo
Lily Whitehurst
Bhaskar K. Somani
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 5/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-019-02878-5

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