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

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.