Comparison of commonly utilized ureteral access sheaths: A prospective randomized trial

Abstract

Objective: We aimed to evaluate and compare the functional characteristics, safety profile and effectiveness of two commonly used ureteral access sheaths (UAS) during flexible ureteroscopy. Methods: After institutional review board approval, patients with proximal ureteral or kidney stones requiring flexible ureteroscopy and UAS were prospectively randomized to group I or group II according to the type of access sheath used. Primary outcome was incidence of intraoperative complications. Results: Eighty-eight patients were enrolled in the study, 44 patients in each group. Sheath size 12/14 FR was used in both cohorts. Median (IQR) stone size was 10 mm (7-13.5) and 10.5 mm (7.37-14) in group I and II respectively (p = 0.915). Nineteen and twenty patients, in group I and II respectively, were pre-stented. Subjective resistance with insertion of the UAS was observed in 9 and 11 patients in group I and II respectively (p = 0.61) while failed insertion was encountered in one patient in group I. Traxer grade 1 ureteral injury was noted in 5 and 6 patients in group I and II respectively while grade 3 injury was seen in 1 patient for both cohorts (p = 0.338). There was less resistance for UAS placement in pre-stented patients (p = 0.0202) but without significant difference in ureteric injury incidence (p = 0.175). Emergency department visits were encountered in 7 (group I) and 5 patients (group II) (p = 0.534). Conclusions: The studied UASs were comparable regarding safety and efficacy in the current study. Pre-stented and dilated ureters had less resistance to insertion although this was not reflected on incidence of ureteric injury.

Effect of perioperative tamsulosin on successful ureteral access sheath placement and stent-related symptom relief: A double-blinded, randomized, placebo-controlled study

“…Although using tamsulosin 2 weeks before surgery appeared advantageous (65.2% vs. 44%), statistical significance was not reached, possibly due to the limited sample size. A recent prospective study reported that using alpha-blockers was not associated with inserting a 12/14F UAS [ 17 ]. However, in this study, only 1 out of 88 patients failed, making it difficult to make a proper comparison.…”

Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review

“…UAS come in various sizes and designs. Some are hydrophilic-coated to facilitate insertion, while others have additional features such as anti-kinking properties, multiple working channels, or suction mechanisms ( Figure-2 ) ( 3 ). The most used calibers are 10-12Fr (where 10 Fr is the internal diameter and 12 Fr is the external diameter), 11-13Fr, 12-14 Fr, or 14/16 Fr.…”

“…In a prospective randomized trial conducted by Elsaqa et al, two types of UAS of 12-14 Fr (Boston Scientific Navigator and Cook Flexor) were compared. The study concluded that both UAS demonstrate similar levels of safety and effectiveness when used in flexible ureteroscopy and RIRS ( 3 ). Huettenbrink et al conducted a prospective study to compare two groups in which UAS of 10/12 Fr and 12/14 Fr were used.…”