Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study

Damar, Erman; Şenocak, Çağrı; Özbek, Rıdvan; Haberal, Hakan Bahadır; SADİOĞLU, Fahri Erkan; Yordam, Mustafa; Bozkurt, Ömer Faruk

doi:10.1080/13645706.2021.1941117

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…Factors associated with post-ureteroscopy opioid prescriptions in 13,143 patients following RIRS included use of a UAS, besides year, younger age, male sex, higher BMI, absence of a pre-operative ureteral stent and stent placed during surgery [ 27 ]. These results are in contrast to the finding of a small prospective study evaluating postoperative pain complications when using a UAS (n = 30) or not (n = 30) during RIRS, in which no significant difference was found between both groups [ 21 ]. Similar finding were reported by Oguz et al [ 28 ].…”

Section: Resultscontrasting

confidence: 99%

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Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

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Section: Resultscontrasting

confidence: 99%

“…Several groups recently investigated if SFRs are influenced by a UAS or not. Three groups found similar SFRs with or without a UAS [ 21 , 22 , 23 ]. Interestingly, two other groups found better SFRs in absence of a UAS.…”

Section: Resultsmentioning

confidence: 99%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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“…ve prospective cohort studies [12,14,15,17,27] and 15 retrospective cohort studies [10, 11, 13, 16, 18-24, 26, 28-30] between the UAS and non-UAS groups. The quality of the included studies was scored between 5 and 8.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Evaluation of the effectiveness and safety of UAS in the treatment of upper urinary tract stones with flexible ureteroscopy lithotripsy: a meta-analysis and systematic review

Guo

Kou

et al. 2023

Preprint

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Objective To investigate the effectiveness and safety of ureteral access sheaths (UAS) in flexible ureteroscopic lithotripsy of upper urinary tract stones through a comprehensive systematic review and meta-analysis.Methods We conducted a meta-analysis and systematic review of the UAS in flexible ureteroscopy lithotripsy on April 12, 2023 (PROSPERO ID : CRD42022368459). The main outcomes of the meta-analysis included stone-free rate (SFR), intra and post-operation complications, hospitalization duration, and operation time.Results Twenty-one studies with 11335 patients satisfied the inclusion criteria. The results showed that compared with the UAS group, the non-UAS group had a higher stone-free rate(SFR) (OR = 0.76, 95%CI 0.60–0.95, P = 0.01) and shorter operation time(MD = 11.21, 95% CI 5.66–16.76, P < 0.00001), but no significant difference in postoperative complications(OR = 1.20, 95% CI 0.79–1.82, P = 0.38), intraoperative complications(OR = 1.20, 95%CI 0.85–1.70, P = 0.57), and hospitalization duration (MD = -0.03, 95%CI -0.30-0.24, P = 0.84).Conclusion Our findings indicate that UAS usage results in unfavorable surgical outcomes with no benefit in preventing surgical complications. Therefore, we recommend re-evaluating the usage of UAS as a surgical aid in patients with large stones.

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“…UAS placement could also provide a continuous outflow of irrigation and might reduce intrarenal pressure and infectious complications [ 66 , 67 ]. However, studies have demonstrated that use of a UAS has no prominent impact on SFR or operation duration [ 68 , 69 ], but does bring an increased risk of ureteric injury [ 70 , 71 ]. Therefore, the placement of a UAS in RIRS may be considered a ‘double‐edged sword’ and should be carefully decided on in each case, taking into consideration its advantages and disadvantages, and surgeon's preference.…”

Section: Guidelinementioning

confidence: 99%

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

et al. 2022

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To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. Materials and MethodsAfter a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. ResultsA total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. ConclusionThe series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.

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Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study

Cited by 12 publications

References 28 publications

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Evaluation of the effectiveness and safety of UAS in the treatment of upper urinary tract stones with flexible ureteroscopy lithotripsy: a meta-analysis and systematic review

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

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