Irrigant Flow and Intrarenal Pressure During Flexible Ureteroscopy: The Effect of Different Access Sheaths, Working Channel Instruments, and Hydrostatic Pressure

Ng, Yeung H.; Somani, Bhaskar K.; Dennison, Andrew; Kata, S.G.; Nabi, Ghulam; Brown, Stuart I.

doi:10.1089/end.2010.0188

Cited by 106 publications

(47 citation statements)

References 11 publications

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“…Specifically, the access sheath allows for multiple entrances in the ureter and facilitates stone fragment extraction. Furthermore, it decreases the intrarenal pressure and therefore allows maintaining a good intraureteroscopic flow that results in better vision [5,22]. In this review, although it was difficult to assess whether ureteral access sheaths were utilized, it appears that its use is common in seven out of 10 studies.…”

Section: Discussionmentioning

confidence: 96%

Retrograde intrarenal surgery for kidney stones larger than 2.5 cm

Breda

Angerri

2014

Current Opinion in Urology

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Section: Discussionmentioning

confidence: 96%

Retrograde intrarenal surgery for kidney stones larger than 2.5 cm

Breda

Angerri

2014

Current Opinion in Urology

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“…The use of ureteral access sheaths improves vision by establishing a continuous outflow, decrease intrarenal pressure, and potentially reduce operating time [12][13][14][15][16]. Ureteral access sheaths allow continuous outflow of irrigation fluid, which improves visual quality and maintains a low-pressure system [16,17]. Ureteral access sheaths are widely accepted and used regularly, despite ongoing debate about potential hazards, including increased ureteral stricture, which has not yet been demonstrated [13].…”

Section: Discussionmentioning

confidence: 99%

Subcapsular renal hematoma after ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy

et al. 2015

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Subcapsular renal hematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser to treat ureteric stones is a rare complication. We aimed to review our unit's experience of post-URSL subcapsular renal hematoma. From 2006 to 2012, 2059 URSLs using F9.5 rigid ureteroscope were performed in our unit. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' renal function, stone characteristics, and degree of renal hydronephrosis were reviewed. Operative data, postoperative information such as clinical manifestation, changes in blood parameters, CT findings, and subsequent treatment were documented. Of the 2059 patients treated with URSL and Ho:YAG laser, three patients were diagnosed as subcapsular renal hematoma after surgery; the age is 57, 61, and 63 years old, respectively. Preoperative imaging examination showed that two patients and one patient had obstructing middle and proximal ureteral stones ranging in size from 0.8 to 1.6 cm, and three patients had thin renal cortices. The double-J ureteral stents were inserted in all cases regularly. All three subcapsular renal hematoma patients had the loin pain of the operation side and fever, and one patient had significant hemoglobin drop (from 111 to 61 g/L) who need to transfusion. Two patients presented within 24 h of URSL, and one patient presented on day 10. One patient was treated conservatively for 3 weeks and recovered with bed rest, antibiotics, hemostasis, and analgesia with no intervention or drain. The other two patients underwent ultrasonography-guided drainage of the hematoma. Two-month follow-up CT scans or ultrasonography confirmed the resolution of the hematoma in all three cases. Renal subcapsular hematoma after URSL is a rare and one of serious complications. Subcapsular renal hematoma should be considered when patients have the symptoms of significant loin pain after URSL for obstructing ureteral stones with thin renal cortices. The treatment of post-URSL renal subcapsular hematomas needs to be customized for each patient.

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“…Irrigation fluid flow rate increases up to sevenfold with increasing sheath diameter, 9 and the larger sheath facilitates passage of the larger digital or dual channel ureteroscopes while enabling the removal of stone fragments up to 4 mm in diameter. 10 …”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Aftermath of Grade 3 Ureteral Injury from Passage of a Ureteral Access Sheath: Disaster or Deliverance?

Okhunov

Kaler

Clayman

2016

Journal of Endourology Case Reports

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Background: The ureteral access sheath (UAS) has revolutionized the management of urinary pathology in the upper tract by providing rapid repeatable access to the upper urinary tract. However, in many practices, it remains a controversial tool in endourology given concerns of possible ureteral injury and presumed long-term sequela from those injuries. This case suggests that these concerns may be more hypothetical than real.Case Presentation: A 32-year-old female with a history of recurrent nephrolithiasis presented with left-sided symptomatic renal colic. She was found to have bilateral nephrolithiasis plus a left 6 × 5 mm proximal ureteral stone with associated moderate hydroureteronephrosis. The patient failed a trial of passage and as such was taken to the operating room for an elective ureteroscopy (URS) during which she sustained a Grade 3 ureteral splitting injury, measuring ∼2–3 cm, to the distal ureter from passage of the 16F UAS. At the end of the procedure a 7/10F endopyelotomy stent was placed. On follow-up URS at 6 weeks, there was no visual evidence of ureteral injury. A Lasix renal scan obtained 8 weeks after stent removal showed no evidence of obstruction.Conclusion: High-grade ureteral injuries sustained from UAS passage are rare. However, when injuries of this nature occur, the concern over long-term damage to the ureter may well be overstated.

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Irrigant Flow and Intrarenal Pressure During Flexible Ureteroscopy: The Effect of Different Access Sheaths, Working Channel Instruments, and Hydrostatic Pressure

Cited by 106 publications

References 11 publications

Retrograde intrarenal surgery for kidney stones larger than 2.5 cm

Retrograde intrarenal surgery for kidney stones larger than 2.5 cm

Subcapsular renal hematoma after ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy

Aftermath of Grade 3 Ureteral Injury from Passage of a Ureteral Access Sheath: Disaster or Deliverance?

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