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

Abstract

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.

Does ureteral access sheath have an impact on ureteral injury?

“…Two of the clinical studies of the current review compared the insertion of the UAS fluoroscopically over a safety wire or under direct vision with the use of a semirigid ureteroscope. [ 22 23 ] Specifically, Hu et al . presented an observational study including 81 upper ureteral stone cases.…”

“…presented an observational study including 81 upper ureteral stone cases. [ 22 ] The UAS was inserted under direct vision with a 6F semirigid ureteroscope. Stone-free rate was 100% and no major complications were seen over a 2-month follow-up period.…”

The Innovative Use of Ureter Catheter in the Surgery of Obstructive Uropathy

“…The incarceration of the stone often causes local edema in the ureter [ 11 ]. When the ureteroscope is inserted, a confined space is formed between the scope and the stone.…”