WCE 2017: Management of Nephrolithiasis with a Large Ureteral Access Sheath is Not Associated with Increased Risk of Surgical Complications and Stricture Formation

Vancouver, Canada (UroToday.com) Dr. Ricardo Soares, endourology fellow from Northwestern University’s Feinberg School of Medicine, presented data that explored the long-term safety of ureteral access sheaths (UAS) use. As an introduction to his talk, Dr. Soares explained although UAS are commonly used for ureteroscopies, there is a lack of data on complications associated with UAS use. To address this, the aim of their study was to retrospectively compare patients who underwent ureteroscopies with and without UAS to evaluate if there was a significant difference between surgical complications and outcomes between patients who had smaller (10-14F) and larger (14/16F) UAS.

With their retrospective collection, they found 355 patients underwent ureteroscopy for nephrolithiasis. Patients who had impacted ureteral stones, incomplete follow up imaging, or obstruction due to another etiology were excluded from the study. Data collected included the patient’s initial three month follow-up CT, JJ stent status, surgical complications, hospital admission, and 90-day readmission rates. Postoperative variables such as hydronephrosis and strictures were evaluated for each patient as well.

Between the two groups, there was a significant difference in stone size with the 14/16 F UAS group having larger stones (10mm vs. 12mm, p<0.001). However, there was no significant difference for intraoperative (3.8% vs 2.8% p = 0.24) and postoperative (6.3% vs 3.9%, p = 0.84) complications, hospital admission, readmission, and stone-free rates. Only 3 out of the 355 patients (0.85) were diagnosed with strictures (2 in 10-14F, 1 in 14/16F UAS). 

In conclusion, Dr. Soares and his team determined surgical complications such as the risk of ureteral stricture formation were low for UAS use during ureteroscopies. They also found that use of a larger UAS (14/16F vs 10-14F) does not have an increased risk of surgical complications. During discussion, Dr. Soares stated because a limitation of the study was it being retrospective, a future direction is to start prospective, randomized trials to definitively evaluate the surgical outcomes associated with the use of UAS.

Presented by: Ricardo Soares 

Authors: Aziz Khambati, Brian Jordan, Sang Gune Yoo, Kent Perry, Robert Nadler, Ricardo Soares
Affiliation: Northwestern University - Feinberg School of Medicine, Evanston IL

Written by: Cyrus Lin, Department of Urology, University of California-Irvine for UroToday.com at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.