Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study

Alkhamees, Mohammad; Aljuhayman, Ahmed; Addar, Abdulmalik; Ghazwani, Yahya; Alasker, Ahmed; Hamri, Saeed Bin

doi:10.4103/ua.ua_94_20

Cited by 7 publications

(12 citation statements)

References 11 publications

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“…Patients who received preoperative ureteral stenting were not included in this study because EAU guidelines did not suggest routine placement of ureteral stents before RIRS [4,6]. Alkhamees and others performed a study to identify the failure rate of insertion of a 10/12-Fr UAS, the outcomes were similar to our study, and in that, no statistically significant difference was found in age, BMI, and stone burden between the success and failure groups [13]. e ureter has 3 physiological strictures (pelvis renal, common iliac vessel crossing, and an intramural portion of the ureter).…”

Section: Discussionsupporting

confidence: 62%

“…To our best knowledge, these factors were first reported to be associated with the insertion of a 12/14-Fr UAS. ere are only a few pieces in the literature focused on the success of UAS placement [3,10,13]. Mogilevkin and others indicated that an indwelling double-J stent, a history of previous ureteroscopy or double-J stent, and older age were significant predictors for an effective 14F UAS insertion In our study, we found sex but not age was a possible predictor for UAS placement, which was similar to a previous study, and anatomical features of the urethra and ureter may be associated with this outcome [11].…”

Section: Discussionmentioning

confidence: 99%

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Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Liu

et al. 2022

International Journal of Clinical Practice

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Purpose. Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods. We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results. Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p = 0.013 ), length of history 15–31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p = 0.045 ), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p = 0.023 ), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p = 0.035 ) were associated with UAS placement. Conclusion. Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Liu

et al. 2022

International Journal of Clinical Practice

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“…Pre-stenting due to failure to access the ureter during URS in adults has been reported at 8-10%. 16,17 Although the European Society for Pediatric Urology guidelines on pediatric stone disease do not specifically recommend the use of ureteral stents, they note the need for pre-stenting for pediatric URS. Additionally, the European guidelines comment on a potential increase in complications in unstented SWL patients.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

et al. 2023

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Study Need and Importance: Ureteral stents cause pain and urinary symptoms for most patients; however, the impact of ureteral stents among pediatric patients undergoing kidney stone surgery is poorly understood. We determined the association between ureteral stents and emergency department (ED) visits and opioid prescriptions for youth having ureteroscopy or shock wave lithotripsy (SWL) to improve the evidence base that informs clinical decision-making for the rapidly growing population of patients with early-onset kidney stone disease. What We Found: In a retrospective cohort study conducted at 6 pediatric health systems that participate in PEDSnet, a clinical research network that aggregates electronic health data, we found that ureteral stents placed before or concurrent with ureteroscopy or SWL were associated with a 33% higher rate of ED visits and a 30% higher rate of opioid prescriptions within 120 days of the index procedure (see Table ). These associations were driven by stents placed before definitive surgery and were higher in magnitude for SWL. Our results strengthen the evidence for the American Urological Association and Endourological Society guidelines, which currently are supported only by expert opinion, to recommend against routine "pre-stenting." Limitations: Limitations introduced by the retrospective observational design include selection bias, unmeasured confounding, and lack of clinically important information such as surgical indications, infection, or whether the stent was left on a string. Interpretation for Patient Care: These results suggest that performing definitive surgery, when possible, rather than "pre-stenting" could reduce the number of pediatric patients who receive stents and reduce postoperative ED visits and opioid prescriptions. To this end, studies are needed to identify situations for which stents could safely be omitted.

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“…A recent study did not identify any patient demographics or stone characteristics that might influence the failure of UAS placement in virgin ureters. 12 The authors were unable to decide whether to proceed with URS, preoperative ureteral stenting, or abortion of the procedure. The latter study missed important factors that may influence UAS…”

confidence: 99%

“…10, 11 However, no factors have been identified to predict UAS insertion in virgin ureters. 12 We believe that other perioperative variables may influence effective UAS insertion, including the surgeon's experience and preoperative medication with αadrenergic blockers, which would relax and relatively dilate the intramural distal ureter. In addition, some experts have reported the impact of the ureteral orifice (UO) shape over a stiff guidewire on the success of UAS introduction, which has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Effective ureteral access sheath insertion during flexible ueteroscopy: Influence of the ureteral orifice configuration

Azhar

Alghamdi

Khawaji

et al. 2022

CUAJ

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Introduction: We sought to determine the possible predictors for effective insertion of the ureteral access sheath (UAS) during flexible ureteroscopy (fURS) in virgin ureters and its impact on postoperative ureteral wall injury and the procedural outcome. Methods: A retrospective review of prospectively collected data was performed for all consecutive patients scheduled for fURS of virgin ureters at two tertiary care centers between 2018 and 2020. Demographics, stone characteristics, and perioperative data, including the configuration of the ureteral orifice (UO) over introductory guidewire insertion, were collected. Multivariate logistic regression was used to detect possible predictors of successful UAS insertion. Results: In total, 128 patients who underwent primary fURS were included, with a mean age of 43.3±12.3 years and a stone burden of 12.3±6.9 mm. One hundred and seven patients (85.9%) achieved successful ureteral access insertion, including 81 (63.3%) without ureteral dilatation and 29 (22.7%) out of the 35 (27.3%) patients who needed ureteral dilation. Patients who underwent successful UAS placement into virgin ureters were significantly older and had a lower body mass index. A tent-shaped UO over the guidewire led to successful UAS insertion. In multivariate regression analysis, cases with body mass index (BMI) <30 kg/m2 (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.28–7.03) and those with a tent-shaped UO over the introductory guidewire (OR 6.60, 95% CI 3.8–7.2) maintained their significance to predict successful UAS insertion into virgin ureters. Nine patients (8.2%) had ureteral mucosal injuries, and the overall stone-free rate was 78.2%. Conclusions: Patients with normal BMIs and tent-shaped UOs over the introductory guidewires are more likely to achieve primary UAS insertion without the need for ureteral dilation.

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Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study

Cited by 7 publications

References 11 publications

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

Effective ureteral access sheath insertion during flexible ueteroscopy: Influence of the ureteral orifice configuration

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