Login to Access Video or Poster Abstract: MP68-02
Sources of Funding: None

Introduction

Ureteral access sheaths (UAS) are commonly used adjuncts to assist with stone retrieval. Despite their common use, there is limited data on long-term safety of UAS use. We sought to evaluate the observed rates of ureteral stricture following ureteroscopy with UAS compared to cases without UAS.

Methods

In a retrospective review, we identified 378 consecutive patients with a new diagnosis of nephrolithiasis managed with ureteroscopy between January 2014 and May 2015. Both the use of UAS and the specific sheath size were assessed (12/14 Fr or 14/16 Fr). The Cook Flexor® sheath was used in all cases. Patients were evaluated for ureteral stricture based on post-operative imaging including ultrasound, CT, MRI, and/or renal scan up to one year after surgery. Patients were excluded from the study if they underwent a concurrent percutaneous or open stone surgery, did not have appropriate follow-up imaging, or had post-operative hydronephrosis or obstruction due to another etiology.

Results

Of the 378 patients, 141 were excluded, primarily for inadequate post-operative imaging; 237 patients were included in the final analysis. The mean age was 54 years, with 106 women and 131 men. Of these, 81 (34.1%) cases included the use of an access sheath, with 12/14 UAS used in 39 cases and 14/16 UAS used in the remaining 42 cases. There were three (1.2 %) ureteral strictures, with mean time to diagnosis of 11 weeks. All cases occurred in the UAS group (p = 0.039) along the proximal ureter/ureteropelvic junction. When stratified by sheath size, two of the 39 cases using a 12/14 sheath developed a stricture, compared with one stricture in the 14/16 group (p = 0.6). Of the three patients with stricture, two were managed with prolonged stenting whereas the last one was lost to follow-up.

Conclusions

While the overall ureteral stricture rate was low (1.2 %) after ureteroscopy, there was a statistically significant increase in stricture rate with UAS. Limitations of this study include the low sample size and lack of control of confounders such as pre-stent status. Large, prospective, randomized studies are required to definitively evaluate the effect of UAS on stricture formation.

Funding

None