Is It a Good Strategy to Proceed a Retrograde Intrarenal Surgery Session Sheathless After Ureteral Access Sheath...

Area of Science:

• Urology
• Endourology
• Minimally Invasive Surgery

Background:

• Ureteral access sheath (UAS) use in retrograde intrarenal surgery (RIRS) is common, but outcomes without it require further investigation.
• Previous findings on UAS effects necessitate understanding sheathless RIRS outcomes, particularly when UAS insertion fails.

Purpose of the Study:

• To compare outcomes of RIRS performed sheathless after a failed UAS insertion versus RIRS planned and completed without a UAS.
• To analyze factors influencing stone-free status and complications in sheathless RIRS procedures.

Main Methods:

• Retrospective analysis of 195 patients undergoing sheathless RIRS for kidney/ureteral stones (2011-2021).
• Patients divided into two groups: planned sheathless (Group 1, n=110) and sheathless after failed UAS insertion (Group 2, n=85).
• Propensity score matching (PSM) created matched cohorts of 76 patients per group for comparison.

Main Results:

• Post-PSM, Group 1 had a significantly higher stone-free rate (90.8%) than Group 2 (76.3%) (p=0.02).
• Group 1 showed significantly lower postoperative complication rates (10.5%) versus Group 2 (27.6%) (p=0.007).
• Group 2 experienced longer operating times and required more unplanned auxiliary procedures compared to Group 1 (p<0.001 for both).

Conclusions:

• Planned sheathless RIRS is associated with superior stone-free rates and reduced complications compared to sheathless RIRS following failed UAS insertion.
• Failed UAS insertion during RIRS can lead to more challenging procedures, increased complications, and lower success rates.
• Stone burden, stone density, and preoperative planning significantly impact RIRS outcomes in sheathless procedures.