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Ureters

Ureters

The ureters are retroperitoneal tubes located on either side of the vertebral column. They are responsible for transporting urine from each kidney to the urinary bladder. These tubes have thick walls and are approximately 25-30 cm long. Their diameter is around 10 mm at the renal pelvis, gradually narrowing to 1 mm as the ureter obliquely enters the posterior bladder wall through the ureteric orifices. The shape of these orifices is slit-like, which helps to prevent urine backflow toward the...

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Updated: Jun 12, 2025

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Published on: November 22, 2019

Ureteral access sheaths in RIRS: a retrospective, comparative, single-center study.

Giuseppe Celentano¹, Biagio Barone², Roberto La Rocca¹

¹Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II Naples, Italy.

Journal of Basic and Clinical Physiology and Pharmacology

|September 19, 2024

Summary

Ureteral access sheaths (UAS) in retrograde intrarenal surgery (RIRS) may increase operative and fluoroscopy times, particularly for smaller stones. Careful evaluation is needed based on stone burden.

Keywords:

RIRS stone-free rate ureteral access sheath

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Area of Science:

Urology
Endourology
Minimally Invasive Surgery

Background:

Ureteral access sheaths (UAS) are utilized in retrograde intrarenal surgery (RIRS) to facilitate stone removal.
The impact of UAS on operative efficiency and patient outcomes requires further investigation.

Purpose of the Study:

To evaluate the effectiveness of UAS in RIRS for kidney stones up to 3 cm.
To assess the influence of UAS on operative time, fluoroscopy duration, stone-free rates (SFR), and complication incidence.

Main Methods:

Retrospective analysis of 234 RIRS procedures for kidney stones (up to 3 cm) between January 2017 and March 2020.
Procedures were divided into those with and without UAS (52.5% utilized UAS).
Outcomes were compared between groups and stratified by stone burden (0.5-1 cm, 1-2 cm, 2-3 cm).

Main Results:

RIRS without UAS showed significantly lower operative time (54.27 vs 62.23 min) and fluoroscopy time (2.72 vs 4.44 min).
Lower residual fragment size was observed without UAS (3.85 vs 4.60 mm).
While fluoroscopy time was consistently lower without UAS across all stone sizes, operative time varied, being lower without UAS for small stones (0.5-1 cm) but higher for medium stones (1-2 cm).

Conclusions:

The use of UAS in RIRS warrants careful consideration due to potential increases in operative and fluoroscopy times.
The decision to use UAS should be individualized based on stone burden and specific surgical context.