Ureteral Access Sheath Use and Infection-Related Hospitalizations: Practice Patterns and Outcomes

Our goal was to compare rates and risk factors for infection-related hospitalizations with and without ureteral access sheath (UAS) use during ureteroscopy (URS) for renal stones.

Using the Michigan Urological Surgery Improvement Collaborative clinical registry, we identified patients who underwent single-stage unilateral URS for renal stones. We assessed variation in UAS usage across practices and surgeons. We compared demographics of cases with and without UAS. Multivariable logistic regression was used to evaluate UAS use and clinical factors on 30-day infection-related hospitalization.

Six thousand one hundred forty-two patients underwent URS by 233 urologists across 34 practices, and 152 (2.5%) had an infection-related hospitalization within 30 days. UAS was used in 59% of cases, with significant variation between practices (4.1%-99.5%, P < .001). Infection-related hospitalization was similar with (2.6%) and without (2.3%) UAS use (P = .5). On multivariable analysis, infection-related hospitalizations did not differ by UAS (odds ratio [OR] 0.8 [95% CI: 0.6-1.2]), but were associated with higher Charlson Comorbidity Index (CCI; CCI 1 vs 0, OR 1.9 [95% CI: 1.2-2.9]; CCI 2+ vs 0, OR 2.3 [95% CI: 1.4-3.6]), history of recurrent UTI (OR 2.4 [95% CI: 1.4-4.0]), larger stones (OR per 5 mm 1.1 [95% CI: 1.0-1.3]), and positive preoperative urinalysis and/or culture (OR 1.8 [95% CI: 1.2-2.7]).

UAS use in URS for renal stones varies across Michigan and was not associated with lower infection-related hospitalization. Prospective studies on the implications of intrarenal pressure are needed.