Treatment of impacted lower third ureteral stones with the use of the ureteral access sheath

We present our experience with the use of the ureteral access sheath for the management of small impacted lower third ureteral stones, in comparison with more standard techniques. Ninety-eight consecutive patients, aged 18–73 years (mean 48.5), with small (diameter < or =10 mm) impacted lower third ureteral stones (<5 mm in 56, and 5–10 mm in 42 patients) were randomly managed with either a 12/14F coaxial ureteral dilator/sheath and a 7.5F flexible ureteroscope (group A; 48 patients), or with balloon dilatation and the 7.5F flexible ureteroscope (group B; 50 patients). In both groups, stones were grasped and extracted with a basket, and when necessary they were disintegrated with a 1.9F electrohydraulic lithotripsy (EHL) probe. Postoperatively, excretory urography was performed at 1 month and patients were followed-up for 1 year. The mean operative time was 45.5 min in group A, and 58.5 min in group B (P<0.05). EHL was performed in 16 (33.3%) patients of group A, and in 12 (24%) patients of group B. In group B, balloon dilatation was performed in 28 (56%) patients. Ureteral perforation was revealed in 4 (8%) patients of group B. The follow-up imaging tests showed stone-free status in 46 (95.8%) patients of group A and in all (100%) patients of group B. No long-term complications were recorded. Endoscopic management of small impacted lower third ureteral stones with the ureteral access sheath is a quicker and safer procedure, in comparison with the more standard approach, bearing comparable efficacy.