Presentation Authors: Jose Eduardo Castro Matheus Rodrigues*, Brian Eisner, Boston, MA
Introduction: Recent studies have described ureteral lesions caused by placement of ureteral access sheaths during ureteroscopy. However, the long-term sequelae of these lesions is unknown. Herein we present medium-term follow up data on ureteral stricture formation in patients who had ureteral access sheath placed during ureteroscopy.
Methods: A retrospective review of consecutive ureteroscopy procedures was performed. Inclusion criteria were the use of ureteral access sheath and minimum of 1 year follow-up clinic visit and abdominal imaging. Exclusion criteria was less than 1 year follow-up data.
Results: One hundred fifty-seven (157) patients met inclusion criteria. Mean age was 61 years (range 27-96) and gender distribution was 56% males and 44% females. Ureteral access sheath diameter was as follows: 9/11 Fr for 2 patients, 10/12 Fr for 5 patients, 11/13 Fr for 40 patients, 12/14 Fr for 73 patients, 13/15 Fr for 37 patients â€“ in total, 95% of patients had 11/13 Fr or larger ureteral access sheath placed. Mean diameter of the largest stone was 6.9 mm (range 2-26 mm), mean operative time was 31 minutes (range 10.5-108 minutes), and contrast extravasation was noted at the time of ureteroscopy in 8 patients (5%). Mean follow up time was 4.1 years (range 1 â€“ 8 years). Most recent follow-up imaging was renal ultrasound in 104 patients, computerized tomography in 45 patients, and MRI in 7 patients. At most recent follow up, 0 patients had persistent hydronephrosis, 0 patients had undergone a procedure or had radiographic demonstration of a ureteral stricture.
Conclusions: In this retrospective study with mean follow up of 4 years, use of ureteral access sheath was not associated with ureteral stricture formation. Future prospective studies would be useful to corroborate these findings.