Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Özman, Oktay; Akgül, Murat; Başataç, Cem; Çınar, Önder; Sancak, Eyüp Burak; Yazıcı, Cenk Murat; Önal, Bülent; Akpınar, Haluk

doi:10.1016/j.ajur.2021.11.004

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Ureteral access sheath (UAS), stone basket usage or pre/postoperative double j stent placement are the common instrumentations. Their use may influence the outcomes of RIRS [ 30 , 31 ]. But surgeon attitudes towards this utilizations complicate the surgical technique standardization of RIRS.…”

Section: Discussionmentioning

confidence: 99%

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Özman

Akgül

Başataç

et al. 2022

Cent european J Urol

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Introduction Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery. Material and methods PubMed and Web of Science databases were searched systematically between April and May 2021. The scoring systems which were validated externally or studied at least by two different researcher groups were selected for further analysis. Of 59 records, 14 studies met the inclusion criteria (n = 4137). Area under curve (AUC) values of selected scoring systems were pooled in random or fixed effects. The I 2 test was used to quantify heterogeneity. Results Eight, 5, 8, 4 and 3 studies included in meta-analyses for the modified Seoul National University Renal Stone Complexity Score (S-ReSC), R.I.R.S., Resorlu-Unsal Score (RUS), S.T.O.N.E., and Ito’s Nomogram, respectively. We found pooled AUC values 0.709 (95% CI 0.670–0.748), 0.704 (95% CI 0.668–0.739), 0.669 (95% CI 0.646 to 0.692), and 0.771 (95% CI 0.724 to 0.818), for first four of them, respectively. Heterogeneity was very high to pool AUC values for Ito’s nomogram. Conclusions Although S.T.O.N.E. score showed higer pooled AUC value, this systematic review and meta-analysis has not revealed superiority of any scoring system. High heterogeneity between studies and dependencies between scoring systems make it difficult to design a comparative statistical model to generalize the findings. Also, limitations aside, neither scoring system has demonstrated good predictive/discriminative performance.

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Section: Discussionmentioning

confidence: 99%

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Özman

Akgül

Başataç

et al. 2022

Cent european J Urol

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“…Our study used UAS(F12/14) intraoperatively in all patients. UAS is a common way to maintain low intrapelvic pressure and reduce the risk of infectious complications 27 , 28 . UAS contributes to low irrigation pressure because it creates a pathway from the collection system to the outside of the body.…”

Section: Discussionmentioning

confidence: 99%

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

Yang

Huang

2023

Sci Rep

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Retrograde intrarenal surgery (RIRS) is one of the main surgical methods for upper urinary calculi, but severe complications of infection may occur after surgery. This study aimed to establish and validate a preoperative nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery to treat upper urinary calculus in patients with a negative preoperative urine culture. We retrospectively recruited 1767 patients with negative preoperative urine cultures who underwent retrograde intrarenal surgery to treat upper urinary calculi from January 2017 to April 2022. The independent risk factors for urosepsis include a solitary kidney, positive urine nitrite, operative time ≥ 75 min, history of recurrent urinary tract infections, and history of diabetes were identified by univariate analysis and multivariate binary logistic regression analysis, which construct a nomogram. The receiver operating characteristic curve of the nomogram for predicting urosepsis was 0.887 in the training cohort and 0.864 in the validation cohort, respectively. The calibration curve and decision curve analysis demonstrated great consistency and clinical utility of the nomogram. Therefore, the nomogram combining preoperative independent risk factors can predict the probability of a postoperative urosepsis following retrograde intrarenal surgery in patients with a negative preoperative urine culture, which could help urologists take preventive measures in advance after surgery to avoid more serious complications of infection.

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“…There is no consensus on the optimal sheath size, but as scopes get iniaturized, it allows for the usage of a smaller calibre UAS. In a recent study, it was shown that, as the UAS calibration increased, the SFR also increased and that calibration increase itself was an independent predictive factor for stone-free status, with the highest predictive value seen with a 10-12 Fr UAS [26].…”

Section: The Utility Of Uas and Recommendations In Guidelinesmentioning

confidence: 99%

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Yuen,

Traxer,

Wroclawski

et al. 2024

Diagnostics

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The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.

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Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Cited by 5 publications

References 21 publications

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

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