Flexible ureteroscopy without ureteral access sheath

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Ureteral access sheath (UAS) use in flexible ureteroscopy and laser lithotripsy (FURS) is common for improved stone clearance and reduced intrarenal pressure.
• However, UAS can increase surgical costs and potentially cause ureteral injury.

Purpose of the Study:

• To compare the safety and efficacy of FURS with and without UAS.
• To determine if UAS is justified in all FURS procedures for upper ureter and renal stones.

Main Methods:

• Retrospective observational study of 241 patients undergoing FURS for upper ureter and renal stones.
• Patients were divided into two groups: those who received UAS and those who did not.
• Comparison of demographic data, stone characteristics, operative time, and postoperative outcomes including infection, pain, and need for further procedures.

Main Results:

• 198 patients (82.2%) were treated without UAS.
• Operative time was significantly shorter in the no-UAS group (64.6 min vs. 89.9 min; p=0.010).
• Ancillary procedures were more frequent in the UAS group (37.2% vs. 21.2%; p=0.026), though this lost significance in multivariate analysis. Rates of colic pain and UTI were similar between groups.

Conclusions:

• FURS without UAS is as safe as FURS with UAS.
• FURS without UAS requires fewer ancillary procedures and has a shorter operative time.
• The routine use of UAS in FURS may not be necessary for all patients.