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Predicting an effective ureteral access sheath insertion: a bicenter prospective study.

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Ureteral access sheath (UAS) insertion before kidney stone treatment can fail in 22% of patients. Older age, prior procedures, and Double-J stents predict successful UAS placement.

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Area of Science:

  • Urology
  • Endourology
  • Nephrolithiasis Management

Background:

  • Ureteral access sheaths (UAS) offer advantages for treating large renal stone burdens.
  • However, UAS passage can be challenging or impossible in some patients.
  • This study evaluates UAS insertion success and predictive factors.

Purpose of the Study:

  • To prospectively assess the feasibility of inserting a 14F UAS.
  • To identify predictors for successful 14F UAS insertion before retrograde intrarenal surgery (RIRS).

Main Methods:

  • A prospective, bicenter study included 248 patients undergoing RIRS.
  • A 14F UAS was initially attempted; dilation was used if passage was difficult.
  • Predictors analyzed included age, gender, BMI, prior ureteroscopy, and Double-J stent presence.

Main Results:

  • 14F UAS insertion failed in 22% of patients.
  • Independent predictors for successful insertion were older age, previous same-side procedures, and an indwelling Double-J stent.
  • Gender, BMI, and surgical side did not predict success.

Conclusions:

  • 14F UAS insertion failure occurs in approximately one-fifth of patients undergoing RIRS.
  • Older age, prior ureteral procedures, and Double-J stents are significant predictors of successful UAS insertion.
  • These findings aid in pre-operative planning for RIRS.