Benefits and risks of ureteral access sheaths for retrograde renal access

Breda, Alberto; Territo, Angelo; López-Martínez, Juan Manuel

doi:10.1097/mou.0000000000000233

Cited by 76 publications

(49 citation statements)

References 24 publications

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“…The assistance of the ureteric guide sheath had certain advantages leading to an improved success rate and efficiency of the operation. According to Breda et al (17), the ureteral access sheath is highly recommended for the treatment of upper urinary tract disease by means of retrograde intrarenal surgery, during which the lower part of the calculus usually causes distortion or partial stricture, resulting in difficulty in using the rigid ureteroscope. In the present study, the placement of the guide sheath straightened the ureteral lumen to a certain extent, which was convenient during surgery, as the ureteral sheath tightly connected to ureteral wall and stretching of the sheath aided to straighten the ureteral cavity during surgery.…”

Section: Discussionmentioning

confidence: 99%

Guide sheath‑assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81�cases

Xie

Yuan

et al. 2018

Exp Ther Med

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The present study assessed the clinical efficacy of guide sheath-assisted ureteroscope lithotripsy in the treatment of upper ureteral calculi. A total of 81 patients with upper ureteral calculi underwent ureteroscope lithotripsy assisted by a guide sheath between January 2012 and June 2014; of these, 63 patients were successfully treated with simple rigid ureteroscope lithotripsy assisted by a ureteral access sheath, and 18 patients were successfully treated with rigid and flexible ureteroscope lithotripsy assisted by a guide sheath. At 1 day after the surgery, ultrasound examination of kidneys, ureters and bladder, and urinary system computed tomography were used to re-check for residual stones, and 69 patients had stones with a diameter of <2 mm in the renal pelvis, while 12 had stones of 2–4 mm in diameter. The operation time was 30–115 min (average, 56.0±4.8 min); all patients underwent a successful surgical procedure. A total of 7 patients had an elevated temperature 37.4–39.1°C (mean temperature, 37.7±0.3°C) after the surgery, but no other major complications were noted. After 1 month, the residual stones were completely discharged, so that the stone clearance rate was 100%. All patients were followed up for 3–12 months and no associated complications occurred. Overall, ureteroscope lithotripsy assisted by a guide sheath for the treatment of upper ureteral calculi had the benefit of water injection and reflux functions, as well as enhanced vision, reduced pressure within the renal pelvis, good discharge of stones as well as an improved efficiency and success rate compared with simple ureteroscopic lithotripsy.

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Section: Discussionmentioning

confidence: 99%

Guide sheath‑assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81�cases

Xie

Yuan

et al. 2018

Exp Ther Med

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“…According to a recent review, the use of ureteral access sheaths for retrograde nephroscopic procedures reduces the risk of ureteral lesions, especially after prestenting. The review did not address larger, unrecognised bleedings 14. One case of spontaneous subcapsular haematoma has previously been reported 15…”

Section: Discussionmentioning

confidence: 99%

Acute renal failure and arterial hypertension due to subcapsular haematoma: is percutaneous drainage a feasible treatment?

2016

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SUMMARYPercutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient did not respond to antihypertensive treatment, Page kidney was suspected. A pigtail catheter was placed in the haematoma and, shortly after drainage, the diuresis resumed and plasma creatinine together with blood pressure decreased. This condition had previously been managed by open surgery, but recent case reports have described successful management by laparoscopyassisted and radiology-assisted drainage, as described in this case report. BACKGROUND

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“…In a lot of these procedures, UASs are being used, due to alleged advantages such as facilitating retrograde intrarenal access, lowering intrarenal pressure, protecting the scope, and expediting stone extraction [13]. On the other hand, the use of UAS, which incontrovertibly has to have a larger diameter than the scope itself, harbours a risk of damaging the ureteral wall, as has been demonstrated in several recent clinical series [3, 4, 6].…”

Section: Discussionmentioning

confidence: 99%

Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

Lildal

Andreassen

Christiansen

et al. 2016

Advances in Urology

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Objective. High intraluminal pressure during ureterorenoscopy (URS) increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs), which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO), when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL) or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (

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Benefits and risks of ureteral access sheaths for retrograde renal access

Cited by 76 publications

References 24 publications

Guide sheath‑assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81�cases

Guide sheath‑assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81�cases

Acute renal failure and arterial hypertension due to subcapsular haematoma: is percutaneous drainage a feasible treatment?

Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

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