Impact of ureteral access sheath force of insertion on ureteral trauma: In vivo preliminary study with 7 patients
Impact of ureteral access sheath force of insertion on ureteral trauma: In vivo preliminary study with 7 patients
BACKGROUND: Ureteral access sheaths (UASs) are commonly used in retrograde intra-renal surgery (RIRS). Despite their advantages, there is a risk of ureteral trauma during their placement and subsequent stricture following surgery. The aim of this study was to evaluate the UAS force of insertion (FOI) during placement and its impact on ureteral trauma.
METHODS: Seven female patients who underwent RIRS for kidney stones were included in the study. A digital force gauge (Chatillon DFX II; Ametek Test and Calibration Instruments, Largo, Florida, USA) was connected to the distal end of the UAS and the UAS FOI was continuously measured during insertion. UASs of different sizes were used and ureteral injury was evaluated under direct vision with the Post-Ureteroscopic Lesion Scale (PULS) score.
RESULTS: Five pre-stented patients and 2 non-stented patients were included in the study. The size of the UASs used in non-stented patients was 9.5/11.5-F and 10/12-F, whereas one 11/13-F and four 12/14-F sheaths were used in the pre-stented patients. The highest maximal UAS FOI observed was 5.9 Newton (N) in a pre-stented patient with a 12/14-F UAS, where a second attempt was performed after initial failure. The lowest maximal UAS FOI was 0.91 N in a non-stented patient using a 9.5/11.5-F UAS. A semirigid ureteroscopy with a 7.8-F sheath was performed in this patient prior UAS placement. The PULS score was 1 in the 2 non-stented patients and 0 in all of the pre-stented patients.
CONCLUSION: In this small cohort, a preoperative JJ stent seemed to protect the ureter, even with larger diameter UASs of 12/14- F. Non-stented RIRS with a UAS is possible, but may cause low-grade ureteral trauma.
Female, Humans, Kidney Calculi/surgery, Ureter/injuries, Urogenital Surgical Procedures/adverse effects
514-520
Tefik, Tzevat
b6fac536-1c56-40af-b46b-639a7596ec16
Buttice, Salvatore
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Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Erdem, Selçuk
73781c4a-37da-4157-a563-80679e6c42d7
Oktar, Tayfun
98e3d681-2ddb-48ea-aeb8-0652c07d82a2
Özcan, Faruk
fc78651e-58c5-47e2-8e34-5df66560409c
Koçak, Taner
0b5e4325-ea86-40eb-abd9-d4d6d878c5e2
Nane, İsmet
c3839e47-07e7-4c81-928e-c9732ceeb159
Traxer, Olivier
2fa78817-b6f8-4f00-b389-c9c9ddbd01f3
November 2018
Tefik, Tzevat
b6fac536-1c56-40af-b46b-639a7596ec16
Buttice, Salvatore
95832a21-ed26-4b33-aed2-08c926408c2c
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Erdem, Selçuk
73781c4a-37da-4157-a563-80679e6c42d7
Oktar, Tayfun
98e3d681-2ddb-48ea-aeb8-0652c07d82a2
Özcan, Faruk
fc78651e-58c5-47e2-8e34-5df66560409c
Koçak, Taner
0b5e4325-ea86-40eb-abd9-d4d6d878c5e2
Nane, İsmet
c3839e47-07e7-4c81-928e-c9732ceeb159
Traxer, Olivier
2fa78817-b6f8-4f00-b389-c9c9ddbd01f3
Tefik, Tzevat, Buttice, Salvatore, Somani, Bhaskar, Erdem, Selçuk, Oktar, Tayfun, Özcan, Faruk, Koçak, Taner, Nane, İsmet and Traxer, Olivier
(2018)
Impact of ureteral access sheath force of insertion on ureteral trauma: In vivo preliminary study with 7 patients.
Turkish Journal of Trauma & Emergency Surgery, 24 (6), .
(doi:10.5505/tjtes.2018.15263).
Abstract
BACKGROUND: Ureteral access sheaths (UASs) are commonly used in retrograde intra-renal surgery (RIRS). Despite their advantages, there is a risk of ureteral trauma during their placement and subsequent stricture following surgery. The aim of this study was to evaluate the UAS force of insertion (FOI) during placement and its impact on ureteral trauma.
METHODS: Seven female patients who underwent RIRS for kidney stones were included in the study. A digital force gauge (Chatillon DFX II; Ametek Test and Calibration Instruments, Largo, Florida, USA) was connected to the distal end of the UAS and the UAS FOI was continuously measured during insertion. UASs of different sizes were used and ureteral injury was evaluated under direct vision with the Post-Ureteroscopic Lesion Scale (PULS) score.
RESULTS: Five pre-stented patients and 2 non-stented patients were included in the study. The size of the UASs used in non-stented patients was 9.5/11.5-F and 10/12-F, whereas one 11/13-F and four 12/14-F sheaths were used in the pre-stented patients. The highest maximal UAS FOI observed was 5.9 Newton (N) in a pre-stented patient with a 12/14-F UAS, where a second attempt was performed after initial failure. The lowest maximal UAS FOI was 0.91 N in a non-stented patient using a 9.5/11.5-F UAS. A semirigid ureteroscopy with a 7.8-F sheath was performed in this patient prior UAS placement. The PULS score was 1 in the 2 non-stented patients and 0 in all of the pre-stented patients.
CONCLUSION: In this small cohort, a preoperative JJ stent seemed to protect the ureter, even with larger diameter UASs of 12/14- F. Non-stented RIRS with a UAS is possible, but may cause low-grade ureteral trauma.
Text
UTD-15263-CLINICAL_ARTICLE-TEFIK
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More information
Accepted/In Press date: 24 October 2018
e-pub ahead of print date: 30 October 2018
Published date: November 2018
Keywords:
Female, Humans, Kidney Calculi/surgery, Ureter/injuries, Urogenital Surgical Procedures/adverse effects
Identifiers
Local EPrints ID: 433334
URI: http://eprints.soton.ac.uk/id/eprint/433334
ISSN: 1306-696X
PURE UUID: 2248f5d1-ce54-4d88-87b4-4909cbfb9ef7
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Date deposited: 14 Aug 2019 16:30
Last modified: 16 Mar 2024 03:24
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Contributors
Author:
Tzevat Tefik
Author:
Salvatore Buttice
Author:
Selçuk Erdem
Author:
Tayfun Oktar
Author:
Faruk Özcan
Author:
Taner Koçak
Author:
İsmet Nane
Author:
Olivier Traxer
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