Laser Doppler Flowmetric Determination of Ureteral Blood Flow after Ureteral Access Sheath Placement

Abstract

In this animal model, the access sheath does cause a transient decrease in ureteral blood flow. Nonetheless, compensatory mechanisms of the ureteral wall restore blood flow to near-baseline rates and preserve urothelial integrity, suggesting that use of the ureteral access sheath remains a safe adjunct to flexible ureteroscopy. Because the chronic effects of the access sheath have yet to be elucidated, care must be taken in selecting an appropriate-size sheath for each individual case. Preventive measures may be available to help avoid sheath-related ureteral injury in those patients identified as high risk.

CUA Guideline: Management of ureteral calculi

“…It has been demonstrated in animal models that the UAS can induce transient ureteral ischemia and promote an acute inflammatory response in the ureter. 76 Furthermore, a recent prospective study has questioned the safety of the UAS, demonstrating the potential for ureteral wall injury in 46.5% of patients. 77 However, no randomized trials exist comparing the incidence of ureteral stricture with and without a UAS.…”

Implementation of Ultramini Percutaneous Nephrolithotomy for Treatment of 2–3 cm Kidney Stones: A Preliminary Report

“…Lallas et al 27 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.…”

Benefits and risks of ureteral access sheaths for retrograde renal access

“…Long-term complication: ureteral stricture Intraluminal compression of the ureter caused by UAS may compromise ureteral blood flow and subsequently induce ureteral ischemia and secondary stricture [3,17,18]. In ureterorenoscopy without the UAS use, the range of ureteral stricture rate reported in large series published is 1-2% [19][20][21].…”