Prostatic morphometric parameters and ureteral access sheath placement failure during retrograde intrarenal surgery:
Ahmet Yıldırım Balık1, Necati Ekici2, Burak Ayvacık3
1Department of Urology, Düzce University Faculty of Medicine, Düzce, 81100, Türkiye. ayildirimbalik@gmail.com.
Purpose:
This study aims to evaluate the potential effect of benign prostatic hyperplasia-related prostatic morphometric parameters on ureteral access sheath (UAS) placement failure in male patients scheduled for retrograde intrarenal surgery (RIRS).
Methods:
Between September 2019 and March 2025, 151 male patients scheduled for RIRS due to renal stones at a tertiary referral center were evaluated retrospectively after applying strict exclusion criteria to obtain a more homogeneous cohort. Patients with a preoperative ureteral stent, prior prostate surgery, alpha-blocker use, urethral or ureteral stricture, or unsuccessful passage of a 7.5 Fr semirigid ureteroscope were excluded. Patients were divided into UAS Successful (n = 93) and UAS Failure (n = 58) groups. Demographic characteristics, including body mass index (BMI), were obtained from the medical records. Hydronephrosis status and prostatic morphometric parameters, including intravesical prostatic protrusion (IPP), prostate volume (PV), prostatic urethral angle (PUA), and prostatic urethral length (PUL), were assessed on preoperative computed tomography by an experienced radiologist.
Results:
In comparative analyses, no statistically significant differences were found between the groups in terms of age, BMI, stone characteristics, or any of the assessed prostatic morphometric parameters (p > 0.05). Preoperative hydronephrosis was more frequent in the UAS Failure Group than in the UAS Successful Group (70.7% vs. 51.6%; p = 0.020). In univariable analysis, preoperative hydronephrosis was associated with higher odds of UAS placement failure (OR: 2.261; 95% CI: 1.127-4.537; p = 0.022). In the adjusted multivariable model, preoperative hydronephrosis remained independently associated with UAS placement failure (adjusted OR: 2.247; 95% CI: 1.103-4.581; p = 0.026), whereas none of the prostatic morphometric parameters showed an independent association. Length of hospital stay was significantly longer in the UAS Failure Group (p = 0.005).
Conclusion:
Prostatic morphometric parameters were not significantly associated with UAS placement failure, whereas preoperative hydronephrosis may be a potential factor associated with UAS placement failure. Given the selected nature of this cohort, larger multicenter studies including patients with a wider range of prostatic anatomy are needed to validate these findings.
