Low occurrence of failure in the ureteral access sheath placement: absence of preoperative critical factors

The use of flexible ureterorenoscopy for the treatment of urinary lithiasis has increased in recent years. Considering a specific technical aspect, some papers have questioned about the need for pre-ureteroscopy measures to facilitate sheath placement.

To record the failure incidence to place a ureteral access sheath (UAS) in flexible ureteroscopy, and discuss if we should use any preoperative measures to optimize this ureteroscopic step.

A retrospective analysis data was carried out from May 2021 to January 2024. Patients who underwent flexible ureterorenoscopy for the treatment of renal lithiasis were included. The groups were subdivided into patients who had been pre-stented and those who were not. The incidence of failure to insert the ureteral sheath was assessed in both groups and the sample' data analyzed, considering p < 0.05 for statistical significance.

A total of 214 patients were analyzed included for study. 41 cases were excluded due to incomplete data in the medical records. The inability to insert the UAS occurred in only 4 patients representing a frequency of 2,31% of the global sample. The failure rate of sheath advancement was 1.9% in the pre-stent group and 3.3% in the treatment-naïve group.

The global failure rate for the placement of UAS in flexible ureterorenoscopy in this retrospective study was 2.31%. Considering the very low failure rate, any routine measure to prepare the ureter for UAS placement may not be necessary.