Abstract: PD16-06
Sources of Funding: Watts Family Fellowship in Urologic Research

Introduction

Prior studies have suggested that larger ureteral access sheaths (UAS) may improve stone free rates (SFR) for larger calculi. The purpose of this study was to directly compare intraoperative and postoperative outcomes and complications between standard (12/14 Fr) and larger (14/16 Fr) ureteral access sheath (UAS).

Methods

We retrospectively reviewed demographic, preoperative, intraoperative, and postoperative data of 257 consecutive patients who underwent ureteroscopy for nephrolithiasis by a single surgeon from January 2013 through July 2015. Patients were separated into 3 groups: no UAS, a 12/14 Fr UAS, or 14/16 Fr UAS. Outcomes included differences in stone-free rate, post-procedure related events (PRE), ureteral injuries and postoperative complications.

Results

A UAS was used in 65.4% (168/257) patients, with 73.8% (124/168) utilizing a 12/14 Fr UAS and 26.2% (44/168) utilizing a 14/16 Fr UAS. Those patients in whom a 14/16 Fr UAS was employed had greater stone burden compared to the 12/14 Fr UAS group (180.8±18.0 vs. 104±9.1 mm2, p<0.001). When comparing 12/14 Fr and 14/16 Fr ureteral access sheaths, there was no significant difference in ureteral injury rate (7.3% vs 4.6%, respectively; p=0.63), complications (10.5% vs 11.4%, respectively; p=0.87), or overall stone-free rate (78.1% vs. 81.3%, p=0.70). The mean amount of stone burden treated per minute of operative time was more than 30% higher in the 14/16 Fr UAS group compared to 12/14 Fr UAS group (2.11 vs 1.62 mm2/min; p=0.01).

Conclusions

The use of a 14/16 Fr UAS allows for similar stone-free rate and improved operative efficiency with no increased risk of ureteral injury or postoperative complications when compared to the 12/14 Fr UAS.

Funding

Watts Family Fellowship in Urologic Research