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Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period
Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

PURPOSE: To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period.

METHODS: The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications.

RESULTS: During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19).

CONCLUSION: The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

0724-4983
1-5
Lima, Ashleigh
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Reeves, Thomas
ca098034-410b-4776-a704-dd88b89cc594
Geraghty, Robert
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Pietropaolo, Amelia
dd6770c4-bf2e-46a9-b7a2-7bd3f9fdba56
Whitehurst, Lily
feb002b4-5f68-46ae-baee-6fe6a1099b65
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Lima, Ashleigh
0fd5efe0-988b-4995-a761-b8d425cd4ca6
Reeves, Thomas
ca098034-410b-4776-a704-dd88b89cc594
Geraghty, Robert
ef19149e-530f-4749-9740-0902fed96fe1
Pietropaolo, Amelia
dd6770c4-bf2e-46a9-b7a2-7bd3f9fdba56
Whitehurst, Lily
feb002b4-5f68-46ae-baee-6fe6a1099b65
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Lima, Ashleigh, Reeves, Thomas, Geraghty, Robert, Pietropaolo, Amelia, Whitehurst, Lily and Somani, Bhaskar K. (2019) Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World Journal of Urology, 1-5. (doi:10.1007/s00345-019-02878-5).

Record type: Article

Abstract

PURPOSE: To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period.

METHODS: The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications.

RESULTS: During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19).

CONCLUSION: The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

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Accepted/In Press date: 16 July 2019
e-pub ahead of print date: 24 July 2019

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Local EPrints ID: 433293
URI: http://eprints.soton.ac.uk/id/eprint/433293
ISSN: 0724-4983
PURE UUID: 4978a5cc-a8dd-413b-8fa7-a8e4c8d5cea8

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Date deposited: 13 Aug 2019 16:30
Last modified: 16 Mar 2024 03:23

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Contributors

Author: Ashleigh Lima
Author: Thomas Reeves
Author: Robert Geraghty
Author: Amelia Pietropaolo
Author: Lily Whitehurst

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