AUA 2018: Perioperative Outcomes of Flexible Ureteroscopy for Urolithiasis using the Sheathless Technique: A Comparative Study

Dr. Benjamin Pradere, the Chief of Clinic at Chru Hôpitaux De Tours, presented on the perioperative outcomes using a sheathless method for flexible ureteroscopy (fURS). As a result of advancing capabilities of flexible ureteroscopes, the interest in sheathless and wireless approaches to fURS has increased. The author opened by explaining current literature that correlates ureteral access sheaths (UAS) deployment to a possible increase ureteral damage and ureteral lesions formation during standard fURS. Therefore, the author noted that a sheathless and wireless approaches could decrease these perioperative complications associated with ureteral damage. The author stated the primary objective of the study was to access the sheathless technique compared to fURS with UAS placement during fURS.

This was a retrospective single center study which consisting of 400 patients who underwent either fURS with a UAS or fURS using the sheathless technique. All fURS were performed using the ureteroscopes URF P5 Olympus. Data collection consisted of operation time, need for basketing, presence of residual fragments, 3-month post-operative stone free rate, and reintervention rate. During the questioning portion, Dr. Pradere would note that stone free criteria included no stones or presence of stones less than 2mm under post-operative imaging.

Stone characteristics such as number of stones, stone size, and stone density, were statistically similar amongst patients who underwent sheathless fURS and fURS with a UAS. Dr. Pradere noted one of the most significant findings was that post-operative complication, stone free rates, and reintervention were not statistically different between both cohorts. In contrast, more stenting and basketing were associate with fURS with UAS placement. Dr. Pradere also addressed that overall operative time was significantly shorter for ureteroscopies with ureteral access sheath, which was approximately 20 minutes less than those patients who underwent the sheathless technique. The presence of residual fragments was not statically significant between either group.

Dr. Pradere concluded that the use of the sheathless method has no statistical impact on stone free rate, reintervention rate, and post-operative complication rate. The sheathless methods of fURS did show to take longer overall, suggesting that normal fURS with a UAS might be preferred given faster procedure and lack of significant differences perioperative outcomes. Dr. Pradere did mention that fURS with the sheathless technique might be beneficial when it comes to procedure cost for the lack of a guidewire, UAS, and even stenting. In response to questions about basketing, the author mention that the majority of surgeons used dusting of stones, which was a common topic addressed through the entire session.

Presented by: Benjamin Pradere, MD

Written by: Luke Limfueco, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA