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


Özman O., Akgül H. M., Başataç C., Çınar Ö., SANCAK E. B., Yazıcı C. M., ...More

Asian Journal of Urology, vol.11, no.1, pp.80-85, 2024 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 11 Issue: 1
  • Publication Date: 2024
  • Doi Number: 10.1016/j.ajur.2021.11.004
  • Journal Name: Asian Journal of Urology
  • Journal Indexes: Scopus
  • Page Numbers: pp.80-85
  • Keywords: Kidney, Retrograde intrarenal surgery, Stone, Ureteral access sheath, Urolithiasis
  • Çanakkale Onsekiz Mart University Affiliated: Yes

Abstract

© 2022 Editorial Office of Asian Journal of UrologyObjective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [−] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS− patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.3%; 11–13 Fr: 91.3%; 13–15 Fr: 100%; p<0.0001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS− patients (27.6%) (p=0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.3%) but was not statistically significant (p=0.08). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.