The Role of 12/14F Ureteral Access Sheath in Flexible Ureteroscopy for Moderate Nephrolithiasis

Abstract

Introduction: The aim was a retrospective analysis of 12/14F ureteral access sheath (UAS) usage on perioperative outcomes in patients with moderate nephrolithiasis (MN). MN was defined as a maximum of two unilateral kidney stones with a maximum stone diameter of 6–10 mm.

Material and Methods: We conducted a monocentric retrospective univariate and multivariate analysis of flexible ureteroscopies (fURS) performed for MN between 01/2014 and 12/2018.

Results: A total of 402 fURS were performed in patients with urolithiasis; 112 MN cases underwent further analysis. UAS was successfully applied in 33 MN cases [33/112 (29.46%)]. UAS was inserted regardless of the maximum kidney stone diameter and the presence of multiple kidney stones (p > 0.05). Univariate analysis revealed a prolonged median operation time (UAS: 94 min, non-UAS: 74 min, p = 0.04) and median fluoroscopy time (UAS: 75 s, non-UAS: 57.5 s, p = 0.04) in the UAS cohort. These differences were not confirmed on multivariate logistic regression.

UAS was not associated with better stone-free rates in either the univariate or multivariate analysis (UAS: 26/33, non-UAS: 61/79, p = 1.0) nor with the occurrence of Clavien-Dindo ≥2 complications (UAS: 3/33, non-UAS: 9/79, p = 0.98) or median length of hospital stay (UAS: 2 days, non-UAS: 2 days, p = 0.169).

Conclusion: We identified no statistical benefits from the usage of 12/14F UAS for MN. As no relevant UAS-associated complications were documented, both strategies (with and without UAS) are feasible.

Zusammenfassung

Hintergrund: Das Ziel der Studie war eine retrospektive Analyse der Auswirkungen der Verwendung der 12/14F Ureterschleuse auf die perioperativen Ergebnisse bei moderater Nephrolithiasis (MN). Diese wurde definiert als maximal zwei einseitige Nierensteine mit einem maximalen Diameter der Konkremente von 6–10 mm.

Material & Methoden: Es wurde eine monozentrische retrospektive univariate und multivariate Analyse von flexiblen Ureterorenoskopien (fURS) bei MN durchgeführt, die im Zeitraum von 01/2014 bis 12/2018 stattfanden.

Ergebnisse: Insgesamt wurden 402 fURS bei Urolithiasis durchgeführt; 112 Fälle MN wurden weiter analysiert. Die UAS wurde erfolgreich in 33 MN Fällen angewendet [33/112 (29.46%)]. Die UAS wurde unabhängig vom maximalen Diameter der Steine und dem Vorhandensein multipler Nierensteine verwendet (p > 0.05). Die univariate Analyse zeigte prolongierte mediane Operationszeiten (UAS: 94min, non-UAS: 74min, p = 0.04) und mediane Durchleuchtungszeiten (UAS: 75s, non-UAS: 57.5s, p = 0.04) in der UAS Kohorte. Diese Unterschiede konnten in der multivariaten logistischen Regression nicht bestätigt werden. Weder in der univariaten noch in der multivariaten Analyse war der Einsatz einer UAS mit höheren Steinfreiheitsraten (UAS: 26/33, non-UAS: 61/79, p = 1.0), dem Auftreten von Clavien Dindo ≥2 Komplikationen (UAS: 3/33, non-UAS: 9/79, p = 0.98) oder der medianen Länge des Krankenhausaufenthaltes (UAS: 2 Tage, non-UAS: 2 Tage, p = 0.169) assoziiert.

Schlussfolgerung: Es konnte kein statistischer Vorteil der Anwendung von 12/14F UAS bei MN gezeigt werden. Da keine UAS-assoziierten Komplikationen festgestellt werden konnten, sind beide Strategien (mit und ohne UAS) möglich.

Schlüsselwörter

Ureteroskopie - flexible Ureterorenoskopie - Nierensteine - Steintherapie - Ureterschleuse

Keywords

ureteroscopy - flexible ureteroscopy - kidney stones - stone therapy - ureteral access sheath

Publikationsverlauf

Eingereicht: 04. Juni 2022

Angenommen nach Revision: 25. Januar 2023

Artikel online veröffentlicht:
14. März 2023

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