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No Difference In Outcomes With And Without A Ureteral Access Sheath For Flexible Ureteroscopy with Laser Lithotripsy
Introduction and Objective
There has been much discussion regarding the advantages and disadvantages of access sheaths in ureteroscopy (URS) and laser lithotripsy. The purpose of this study was to identify outcomes and complications associated with use of access sheaths during flexible ureteroscopy with laser lithotripsy
Methods
Retrospective chart review was conducted on all URS cases for renal and ureteral stones performed by three surgeons at one institution from January 2007 to January 2013. Access sheath use was analyzed. Reviewed complications included UTI, urosepsis, readmission, or requirement of second procedure. Post-operative imaging also reviewed for post-operative hydronephrosis. Treatment success rate was determined.
Results
Six hundred eighty-seven patients were identified for a total of seven hundred fifty-seven renal units. Mean patient age was 51 years. Average stone size was 8.7 mm. In patients with access sheath, average stone size was 8.95 mm. In patients without access sheath, the average stone size was 8.5 mm. The overall stone-free rate was 96%. An access sheath was used in three hundred fifty-one patients. The complication rate was 6.26% with the use of an access sheath, while the complication rate was 8.37% in patients without the use of an access sheath. On univariate analysis, the complication rates with and without the use of access sheath were not found to be significant (p > 0.05). In patients without access sheath, 2.22% patients had post-operative hydronephrosis. In those patients with access sheath, 5.40% patients had post-operative hydronephrosis (p > 0.05). In all patients except one, who ultimately required surgery, the post-operative hydronephrosis resolved without intervention. The patient with unresolved post-operative hydronephrosis had ureteroscopy without access sheath.
Conclusion
In this study, there was no difference in complications or in stone free rates of ureteroscopy with laser lithotripsy regardless of whether or not a ureteral access sheath was used. There was no difference in stricture formation or post-operative sepsis in patients with and without access sheath.
Table 1.

Mean age	51.64 ±14
Gender
Male	411
Female	346
Mean stone size	8.73 mm
Access Sheath	8.95mm
No Access Sheath	8.5 mm

Table 2.

	Stone-Free Rate	Complication Rate
Access Sheath	333/351 (94.9%)	22/351 (6.26%)	p > 0.05
No Access Sheath	393/406 (96.8%)	34/406 (8.37%)	p > 0.05

Table 3.

	Post-operative Hydronephrosis

Access Sheath	19/351 (5.40%)	p > 0.05
No Access Sheath	9/406 (2.22%)	p > 0.05