Presentation Authors: Melih Balci*, Altug Tuncel, Ahmet Asfuroglu, Can Aykanat, Ozer Guzel, Yilmaz Aslan, Ankara, Turkey
Introduction: Placement of the ureteral access sheath (UAS) carries an increased risk of ureteral wall ischaemia and injury to the mucosal or muscular layers of the ureter, and it theoretically causes increased risk of ureteral stricture. In the current study, we aim to analyze the incidence of ureteral stricture in a series of patients who underwent retrograde intrarenal surgery (RIRS) with using UAS.
Methods: Between September 2016 and September 2018, 154 consecutive RIRS procedures with adjunctive use of an UAS for kidney stone were prospectively included the study. Local ethic committee approval was obtained. A 9.5/11.5-f UAS (Cook Medical, Dublin, Ireland) (35cm or 45cm length for females or males, respectively) was used during procedures. All patients were evaluated by computed tomographic urography in the first year after treatment. A stricture is defined as a fixed narrowing with proximal dilatation. Exclusion criteria were previous stone history, previous, urinary surgery and any urinary system anomalies.
Results: The mean age of the patients was 47Â±15 (12-81) years. Of the patients, 86 were male and 68 were female. Mean stone size was 17.1Â±8 (7-40) mm and mean operative time was 56Â±23 (30-120) minutes. Immediate stone-free rate was achieved in 118 (76.6%) patients in the first session. After first session, 30 patients underwent second session RIRS. The total SFR was 90.2%. A total of 5 patients (3.2%) had minor complications, including hematuria and fever. Urinary sepsis developed as a major complication in 3 patients (1.9%). No ureteral stricture was detected in the patients at first year control.
Conclusions: The results of our series indicate that the 9.5/11.5-f UAS is safe for routine use to facilitate flexible ureteroscopy. However, awareness of the potential ischemic effects with the use of unnecessarily large sheaths for long periods in patients at risk of ischemic injury should be considered.