Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts

Law, Yu Xi Terence; Teoh, Jeremy Yuen‐Chun; Castellani, Daniele; Lim, Ee Jean; Chan, Erica On-Ting; Wroclawski, Marcelo Langer; Pirola, Giacomo Maria; Giulioni, Carlo; Rubilotta, Emanuele; Gubbioti, Marilena; Scarcella, Simone; Chew, Ben H.; Traxer, O.; Somani, Bhaskar; Gauhar, Vineet

doi:10.1007/s00345-022-03935-2

Cited by 23 publications

(24 citation statements)

References 43 publications

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“…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]. Many studies have suggested that indwelling double-J stents result in higher success rates for UAS placement as ureteral stenting increases the luminal circumference of ureters [1,4,5,14]. 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].…”

Section: Discussionsupporting

confidence: 88%

“…Retrograde intracranial surgery (RIRS) is a treatment option for renal or proximal ureteral stones [1]. Ureteral access sheaths (UAS) increase visibility, reduce operating time, and allow multiple reentries to the ureter and are widely used in RIRS [2].…”

Section: Introductionmentioning

confidence: 99%

“…However, failure rates of ureteroscopy due to a difficult impassable ureter range from 8% to 10%, and approximately 22% of patients fail to insert a standard UAS [3]. Stent placement before RIRS can theoretically expand the ureter to improve access, and data showed prestenting resulted in higher success for UAS placement and also minimized intraoperative ureteric injury [1,4]. In vitro experiments showed that one week of ureteral stenting resulted in nearly a 4Fr increase in the luminal circumference of porcine ureters [5].…”

Section: Introductionmentioning

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: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Two groups recently performed a meta-analysis to investigate the outcomes of pre-operative ureteral stenting for RIRS [ 54 , 55 ]. They both found that pre-stenting resulted in a higher success for UAS placement, lower intraoperative ureteric injuries and higher overall SFRs (defined as no residual fragment at all) [ 54 , 55 ]. In a recent study on porcine ureters, one week of prestenting resulted in a 3.8 Fr increase in the luminal diameter [ 56 ], as measured by xyz-methodology.…”

Section: Resultsmentioning

confidence: 99%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

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“…Retrograde intrarenal surgery (RIRS) is one of the first-line options for renal or proximal ureteral stones up to 20 mm [ 1 ]. Ureteral access sheaths (UAS) increase visibility, reduce operation time, and allow multiple re-entries to the ureter while reducing intrarenal pressure and providing drainage for irrigation fluids [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

CT-Based Predictor for the Success of 12/14-Fr Ureteral Access Sheath Placement

Liu

et al. 2022

International Journal of Clinical Practice

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Purpose. Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. Methods. We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. Results. Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. Conclusion. Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.

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Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts

Cited by 23 publications

References 43 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 Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

CT-Based Predictor for the Success of 12/14-Fr Ureteral Access Sheath Placement

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