Skip to main content
Erschienen in: World Journal of Urology 1/2014

01.02.2014 | Original Article

The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones

verfasst von: Gaetan Berquet, Paul Prunel, Grégory Verhoest, Romain Mathieu, Karim Bensalah

Erschienen in: World Journal of Urology | Ausgabe 1/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the impact of a ureteral access sheath (UAS) on stone-free (SF) rate after flexible ureteroscopy for upper urinary tract stones.

Materials and methods

We retrospectively reviewed 280 patients who underwent flexible ureteroscopy (URS) for upper urinary tract stone between 2009 and 2012. Patients were divided into two groups based on whether a UAS was used (n = 157) or not (n = 123). SF rate was evaluated at one and three months after surgery by abdominal imaging. Quantitative and qualitative variables were compared with Student’s t test and χ2 test, respectively. A logistic regression model was used to determine the predictive factors of SF status.

Results

Stone size was similar in both groups (15.1 vs. 13.7 mm, p = 0.21). SF rates at one and 3 months were comparable in UAS and non-UAS groups (76 vs. 78 % and 86 vs. 87 %, p = 0.88 and 0.89, respectively). Complication rates were similar in both groups (12.7 vs. 12.1 %, p = 0.78). In multivariable analysis, stone size was the only predictive factor of SF rate (p = 0.016).

Conclusion

The routine use of a UAS did not improve SF rate in patients undergoing flexible URS for upper urinary tract calculi.
Literatur
1.
Zurück zum Zitat Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21:119–123PubMedCrossRef Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21:119–123PubMedCrossRef
2.
Zurück zum Zitat Vanlangendonck R, Landman J (2004) Ureteral access strategies: pro-access sheath. Urol Clin North Am 31:71–81PubMedCrossRef Vanlangendonck R, Landman J (2004) Ureteral access strategies: pro-access sheath. Urol Clin North Am 31:71–81PubMedCrossRef
3.
Zurück zum Zitat Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718PubMedCrossRef Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718PubMedCrossRef
4.
Zurück zum Zitat Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165:789–793PubMedCrossRef Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165:789–793PubMedCrossRef
5.
Zurück zum Zitat Auge BK, Pietrow PK, Lallas CD et al (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36PubMedCrossRef Auge BK, Pietrow PK, Lallas CD et al (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36PubMedCrossRef
6.
Zurück zum Zitat L’Esperance JO, Ekeruo WO, Scales CD Jr et al (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255PubMedCrossRef L’Esperance JO, Ekeruo WO, Scales CD Jr et al (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255PubMedCrossRef
7.
Zurück zum Zitat Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584PubMedCrossRef Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584PubMedCrossRef
8.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef
9.
Zurück zum Zitat Wignall GR, Canales BK, Denstedt JD et al (2008) Minimally invasive approaches to upper urinary tract urolithiasis. Urol Clin North Am 35:441–454PubMedCrossRef Wignall GR, Canales BK, Denstedt JD et al (2008) Minimally invasive approaches to upper urinary tract urolithiasis. Urol Clin North Am 35:441–454PubMedCrossRef
10.
Zurück zum Zitat Chow GK, Patterson DE, Blute ML (2003) JW: Ureteroscopy: effect of technology and technique on clinical practice. J Urol 170:99–102PubMedCrossRef Chow GK, Patterson DE, Blute ML (2003) JW: Ureteroscopy: effect of technology and technique on clinical practice. J Urol 170:99–102PubMedCrossRef
11.
Zurück zum Zitat Wendt-Nordahl G, Mut T, Krombach P et al (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39:185–188PubMedCrossRef Wendt-Nordahl G, Mut T, Krombach P et al (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39:185–188PubMedCrossRef
12.
Zurück zum Zitat Breda A, Ogunyemi O, Leppert JT et al (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196PubMedCrossRef Breda A, Ogunyemi O, Leppert JT et al (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196PubMedCrossRef
13.
Zurück zum Zitat Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108–111PubMedCrossRef Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108–111PubMedCrossRef
14.
Zurück zum Zitat Srisubat A, Potisat S, Lojanapiwat B, et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044 Srisubat A, Potisat S, Lojanapiwat B, et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044
15.
Zurück zum Zitat Takayasu H, Aso Y (1974) Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol 112:176–178PubMed Takayasu H, Aso Y (1974) Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol 112:176–178PubMed
16.
Zurück zum Zitat Aboumarzouk OM, Monga M, Kata SG, et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26(10):1257–1263 Aboumarzouk OM, Monga M, Kata SG, et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26(10):1257–1263
17.
Zurück zum Zitat Aboumarzouk OM, Somani B and Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110(8 Part B):E374–380 Aboumarzouk OM, Somani B and Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110(8 Part B):E374–380
18.
Zurück zum Zitat Sofer M, Watterson JD, Wollin TA et al (2002) Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31–34PubMedCrossRef Sofer M, Watterson JD, Wollin TA et al (2002) Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31–34PubMedCrossRef
19.
Zurück zum Zitat Hyams ES, Bruhn A, Lipkin M et al (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24:1411–1414PubMedCrossRef Hyams ES, Bruhn A, Lipkin M et al (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24:1411–1414PubMedCrossRef
20.
Zurück zum Zitat Rebuck DA, Macejko A, Bhalani V et al (2011) The natural history of renal stone fragments following ureteroscopy. Urology 77:564–568PubMedCrossRef Rebuck DA, Macejko A, Bhalani V et al (2011) The natural history of renal stone fragments following ureteroscopy. Urology 77:564–568PubMedCrossRef
21.
Zurück zum Zitat El-Nahas AR, El-Assmy AM, Madbouly K et al (2006) Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. J Endourol 20:870–874PubMedCrossRef El-Nahas AR, El-Assmy AM, Madbouly K et al (2006) Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. J Endourol 20:870–874PubMedCrossRef
22.
Zurück zum Zitat Buchholz NP, Meier-Padel S, Rutishauser G (1997) Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation? J Endourol 11:227–232PubMedCrossRef Buchholz NP, Meier-Padel S, Rutishauser G (1997) Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation? J Endourol 11:227–232PubMedCrossRef
23.
Zurück zum Zitat Kang DE, Maloney MM, Haleblian GE et al (2007) Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol. 177:1785–1788 discussion 1788–1789PubMedCrossRef Kang DE, Maloney MM, Haleblian GE et al (2007) Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol. 177:1785–1788 discussion 1788–1789PubMedCrossRef
24.
Zurück zum Zitat Abrahams HM, Stoller ML (2004) The argument against the routine use of ureteral access sheaths. Urol Clin North Am 31:83–87PubMedCrossRef Abrahams HM, Stoller ML (2004) The argument against the routine use of ureteral access sheaths. Urol Clin North Am 31:83–87PubMedCrossRef
25.
Zurück zum Zitat Lallas CD, Auge BK, Raj GV et al (2002) Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol 16:583–590PubMedCrossRef Lallas CD, Auge BK, Raj GV et al (2002) Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol 16:583–590PubMedCrossRef
26.
Zurück zum Zitat Delvecchio FC, Auge BK, Brizuela RM et al (2003) Assessment of stricture formation with the ureteral access sheath. Urology. 61:518–522 discussion 522PubMedCrossRef Delvecchio FC, Auge BK, Brizuela RM et al (2003) Assessment of stricture formation with the ureteral access sheath. Urology. 61:518–522 discussion 522PubMedCrossRef
Metadaten
Titel
The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones
verfasst von
Gaetan Berquet
Paul Prunel
Grégory Verhoest
Romain Mathieu
Karim Bensalah
Publikationsdatum
01.02.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
World Journal of Urology / Ausgabe 1/2014
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-013-1181-5

Weitere Artikel der Ausgabe 1/2014

World Journal of Urology 1/2014 Zur Ausgabe

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Harninkontinenz: Netz-Op. erfordert über lange Zeit intensive Nachsorge

30.04.2024 Harninkontinenz Nachrichten

Frauen mit Belastungsinkontinenz oder Organprolaps sind nach einer Netz-Operation keineswegs beschwerdefrei. Vielmehr scheint die Krankheitslast weiterhin hoch zu sein, sogar höher als von harninkontinenten Frauen, die sich nicht haben operieren lassen.

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.