Different ureteral access sheaths sizes for retrograde intrarenal surgery

Area of Science:

• Endourology
• Urologic Stone Disease
• Minimally Invasive Surgery

Background:

• The trend towards miniaturization in endourological stone therapy necessitates effective ureteral access sheaths.
• Ureteral sheaths are crucial for maintaining visibility, intrarenal pressure, and temperature control during procedures.

Purpose of the Study:

• To compare the efficacy of 10/12 Charr. and 12/14 Charr. ureteral access sheaths in flexible ureterorenoscopy.
• To evaluate stone-free rates, complication rates, and laser lithotripsy effectiveness between the two sheath sizes.

Main Methods:

• A retrospective analysis of 200 patients (100 per group) undergoing flexible ureterorenoscopy for kidney stones up to 1.5 cm.
• Comparison of perioperative data, stone characteristics, laser parameters, stone-free rates, and complications (Clavien-Dindo classification) between 10/12 Charr. and 12/14 Charr. ureteral sheaths.

Main Results:

• No significant differences were observed in median surgery duration, overall complication rates, or hospitalization duration between the two sheath sizes.
• Stone-free rates were comparable (97.9% for 12/14 Charr. vs. 92.7% for 10/12 Charr., p=0.37).
• The 10/12 Charr. sheaths required significantly longer laser duration (3.8 min vs. 1.9 min, p<0.01) and higher laser energy (6.8 J vs. 3.1 J, p<0.01) compared to the 12/14 Charr. sheaths.

Conclusions:

• Ureteral access sheath size (10/12 Charr. vs. 12/14 Charr.) does not impact stone-free rates in flexible ureterorenoscopy.
• While smaller sheaths (10/12 Charr.) necessitate increased laser parameters, they do not elevate the risk of clinical complications such as trauma or inflammation.