Korean J Urol.  2009 Apr;50(4):355-360.

Efficacy of Ureteroscopic Removal of Stones with an Ureteral Access Sheath for the Treatment of Ureteral Calculi

• Hyun CH
• Song PH
• Kim HT
• Jung HC

Abstract

PURPOSE
The ureteral access sheath (UAS) was developed to facilitate difficult ureteroscopic procedures. However, some have questioned the safety of the UAS and its likelihood of causing significant ureteral traumas. We evaluated the efficacy and safety of a UAS for managing ureteral calculi. MATERIALS AND METHODS: From July 2005 to June 2008, a total of 122 patients underwent ureteroscopic removal of stones (67 patients with UAS, 55 patients without UAS). Under local, spinal, or general anesthesia, all patients were treated by using a semirigid ureteroscope with or without UAS. The operative results of the patients were assessed with KUB, and excretory urography or ultrasonography were assessed postoperatively after 2 to 4 weeks. We also analyzed the success rates of stone removal and the complication rates for each procedure. RESULTS: Mean stone size and mean operation time were 9.3 mm and 38.8 minutes, respectively, with UAS and 8.9 mm and 40.4 minutes, respectively, without UAS. Overall stone-free rates were 89.6% and 76.4%. Mean hospital stay was 2.0 days and 2.2 days. The time for operation was significantly decreased for upper ureteral stones treated with UAS (p=0.022). The stone-free rates were higher for upper ureteral stones treated with UAS (28/32, 87.5%, p=0.027), especially for stones greater than 10 mm in size (p=0.048). CONCLUSIONS: The use of UAS is effective and safe. The stone-free rates of ureteroscopic removal of stones with UAS were significantly higher than the rates without UAS for large (> or =10 mm) upper ureteral calculi.

Keyword

Ureteral calculi; Ureteroscopy; Equipment and supplies

MeSH Terms

Anesthesia, General
Equipment and Supplies
Humans
Length of Stay
Ureter
Ureteral Calculi
Ureteroscopes
Ureteroscopy
Urography

Figure

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  Fig. 1 Ureteral access sheath. Applied Forté® AxP (Rancho Santa Margarita, USA). (A) 14/16 Fr. 35 cm ureteral access sheath consisting of a two-piece device: an inner tapered obturator, an outer working sheath, and a funnel-shaped ergonomic entry port. (B) The inner obturator extended beyond the 16 Fr. outer working sheath.

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  Fig. 2 Fluoroscopy showing the access sheath in the right midureter with the ureteroscope inserted alongside the guidewire.

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