A Prospective Study Analyzing the Association Between High-grade Ureteral Access Sheath Injuries and the Formation of Ureteral Strictures.

To assess the intermediate- and long-term effect of high-grade ureteral injuries from ureteral access sheaths.

Patients undergoing ureteroscopy for upper tract calculi were prospectively enrolled at 2 sites from 2010 to 2015.

A 12/14 French sheath was used and the ureter was inspected with a flexible ureteroscope during withdrawal of the sheath and recorded. The videos were then evaluated by 2 blinded endourologists, and any injuries were graded per the Traxer ureteral injury scale. Only high-grade injuries were included. The primary endpoint was defined as ongoing hydronephrosis without an obstructing stone on follow-up imaging indicating a ureteral stricture. Logistic regression analysis was used to assess the relationship between hydronephrosis, ureteral injury, and other patient variables.

Fifty-six patients were identified with high-grade ureteral injuries. Sixteen patients (28.6%) were female. Median age was 56.4years (range 14-85). Median follow-up was 35.8 months (range 0-88). Three patients (5.5%) had hydronephrosis on follow-up imaging, only 1 of whom developed a de novo ureteral stricture. On univariate analysis, hydronephrosis was associated with a shorter stent duration (P = .11) and older age (P = .17).

Endoscopically identified high-grade ureteral lesions following ureteral access sheath placement do not lead to clinically significant sequelae on intermediate term follow-up, with a stricture rate comparable to those without visible injuries of 1.8%.

Urology. 2019 Mar 14 [Epub ahead of print]

Karen L Stern, Christopher J Loftus, Steeve Doizi, Olivier Traxer, Manoj Monga

Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH. Electronic address: ., University of Washington Medical Center, Department of Urology, Seattle, WA., Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France., Hospital Tenon, Universite Pierre et Marie Curie, Department of Urology, Paris, France., Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.