Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Use of a modified ureteral access sheath in semi-rigid ureteroscopy to treat large upper ureteral stones is associated with high stone free rates

Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).

Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery:A case report

BACKGROUND Retrograde intrarenal surgery(RIRS)has been proven to be a safe and effective treatment modality in large-scale quantitative studies.However,although its safety profile has been established,it also has a potential risk of life-threatening complications.We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria.An enhanced computed tomography(CT)scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis.The patient underwent RIRS.During the surgery,a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter.On postoperative day 1,she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness.A follow-up CT scan was taken,which revealed a huge hematoma in the periureteral space,not in the perirenal space,with suspicious contrast medium extravasation.Immediate angiography was performed;however,it showed no evidence of active bleeding.She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy,and was discharged on postoperative day 7.However,she visited our outpatient department with recurrent left flank pain at 5 d from discharge.Ultrasonography confirmed that the double J-stent was intact.To rule out stent malfunction,the stent was changed.Decreased size of the hematoma was observed in the imaging studies,and conservative management for candiduria was performed for 1 wk.CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones,clinicians should be aware of its potential complications.