Background:
Recent studies have described ureteral lesions caused by the placement of ureteral access sheaths during ureteroscopy. However, the long-term sequelae of these lesions are not well understood. Herein, we present a long-term follow-up data on ureteral stricture formation in patients who had a ureteral access sheath placed during retrograde ureteroscopy.Methods:
An IRB-approved retrospective review of consecutive retrograde ureteroscopy procedures between January 2009 to December 2018 was performed. Inclusion criteria was the use of a ureteral access sheath and a minimum of 1 year follow-up with abdominal imaging. Exclusion criteria was patients who had stricture at the time of the index operation.Results:
A total of 436 patients were included. Mean age was 64 years old (range 22-96) and gender distribution was 54.2% males and 45.8% females. Ureteral access sheath diameter was as follows: 9/11 Fr (2 patients), 10/12 Fr (5 patients), 11/13 Fr (283 patients), 12/14 Fr (104 patients), 13/15 Fr (42 patients). Overall, 98.4% of patients had an 11/13 Fr or larger ureteral access sheath placed. Mean diameter of the largest stone was 10.1 mm (range 2-54 mm), mean operative time was 30.5 minutes (range 9-108 minutes), and contrast extravasation was noted at the time of ureteroscopy in 21 patients (4.8%). Mean follow-up time was 5.9 years (range 1-13.2 years). Most recent follow-up imaging was a renal ultrasound in 208 patients, computerized tomography in 204 patients, and MRI in 24 patients. At the most recent follow-up, 9 patients (2.0%) had undergone a procedure or had radiographic demonstration of a ureteral stricture.Conclusion:
In this retrospective study with a mean follow-up of 6 years, the incidence of stricture development after ureteroscopy with the use of ureteral access sheaths is low and does not appear higher than the reported incidence of stricture after stone passage or stone treatment in general. Future prospective studies with longer mean follow-up times would be helpful to further corroborate these findings.
