Dr. Patel presented prospective data that showed use of access sheaths significantly reduced pressures in the calyxes and renal pelvis under uninterrupted pressurized irrigation of 150mmHg. Without access sheaths, pressures within the calyx reached over 40mmHg. Access sheaths of greater diameters also led to progressively decreased pressures. In addition, Dr. Patel presented data from a non-survival porcine study showing that the center of the papilla routinely had the least amount of blood flow, whereas the 6 o’clock position of the papillae had the most amount of blood flow. In addition, the upper, inner, and lower pole calyxes had no differences in the amount of bleeding.
Dr. Patel has several take-home points. Access sheaths can reduce pressures and should be universally used. In addition, the controversial nature of access sheaths may be overstated. In prospective data, there is no association or indication between use of access sheath and ureteral stricture, ureteral injury, or ureteral bleeding1. In addition, the ideal puncture for percutaneous access would be the center of the papillae because it routinely had the least amount of blood flow.
Presented by: Roshan M. Patel, MD, Department of Urology, Assistant Professor of Clinical Urology, Director of the Kidney Stone Center, University of California, Irvine, California
Written by: Lillian Xie, BA, Department of Urology, University of California, Irvine, California at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates
1. Traxer, Olivier, Gunnar Wendt-Nordahl, Hiren Sodha, Jens Rassweiler, Shimon Meretyk, Ahmet Tefekli, Fernando Coz, and J. Jean. "Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study." World journal of urology 33, no. 12 (2015): 2137-2144.