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

• References

• 1 Zilberman DE, Lazarovich A, Winkler H. et al. Practice patterns of ureteral access sheath during ureteroscopy for nephrolithiasis: a survey among endourologists worldwide. BMC Urol 2019; 19: 58
• 2 MacCraith E, Yap LC, Elamin M. et al. Evaluation of the Impact of Ureteroscope, Access Sheath, and Irrigation System Selection on Intrarenal Pressures in a Porcine Kidney Model. J Endourol 2021; 35: 512-517
• 3 Rehman J, Monga M, Landman J. et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 2003; 61: 713-718
• 4 Noureldin YA, Kallidonis P, Ntasiotis P. et al. 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: 725-729
• 5 Meier K, Hiller S, Dauw C. et al. Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes. J Endourol 2021; 35: 1340-1347
• 6 Geraghty RM, Ishii H, Somani BK. Outcomes of flexible ureteroscopy and laser fragmentation for treatment of large renal stones with and without the use of ureteral access sheaths: Results from a university hospital with a review of literature. Scand J Urol 2016; 50: 216-219
• 7 Huang J, Zhao Z, AlSmadi JK. et al. Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis. PLoS One 2018; 13: e0193600
• 8 Traxer O, Wendt-Nordahl G. 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: 2137-2144
• 9 L'esperance JO, Ekeruo WO, Scales Jr CD. et al. Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 2005; 66: 252-255
• 10 Berquet G, Prunel P, Verhoest G. et al. 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: 229-232
• 11 Türk C, Petřík A, Sarica K. et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016; 69: 475-482
• 12 Assimos D, Krambeck A, Miller NL. et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 2016; 196: 1153-1160
• 13 Ozimek T, Cordes J, Gilbert N. et al. Laser fibre, rather than the stone, may harm the scope: retrospective monocentric analysis of 26 pre- and intraoperative factors of flexible ureteroscope (fURS) damage. World J Urol 2020; 38: 2035-2040
• 14 Ozimek T, Kramer MW, Hupe MC. et al. The Impact of Endourological Experience on Flexible Ureteroscopy Outcomes and Performance at Different Levels of Expertise: Retrospective Multifactorial Analysis. Urol Int 2020; 104: 452-458
• 15 Karim SS, Hanna L, Geraghty R. et al. Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Urolithiasis 2020; 48: 263-270
• 16 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
• 17 Bone RC, Balk RA, Cerra FB. et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644-1655
• 18 Wright A, Williams K, Somani B. et al. Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments. Cent European J Urol 2015; 68: 434-438
• 19 Zhong W, Zeng G, Wu K. et al. Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever?. J Endourol 2008; 22: 2147-2151
• 20 Reicherz A, Maas V, Reike M. et al. Striking a balance: outcomes of short-term Mono-J placement following ureterorenoscopy. Urolithiasis 2021; 49: 567-573
• 21 Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy?. J Urol 2001; 165: 789-793
• 22 Al-Qahtani SM, Letendre J, Thomas A. et al. Which ureteral access sheath is compatible with your flexible ureteroscope?. J Endourol 2014; 28: 286-290
• 23 Kaler KS, Lama DJ, Safiullah S. et al. Ureteral Access Sheath Deployment: How Much Force Is Too Much? Initial Studies with a Novel Ureteral Access Sheath Force Sensor in the Porcine Ureter. J Endourol 2019; 33: 712-718
• 24 Pedro RN, Weiland D, Reardon S. et al. Ureteral access sheath insertion forces: implications for design and training. Urol Res 2007; 35: 107-109