Different ureteral access sheaths sizes for retrograde intrarenal surgery

Abstract

Purpose: There is a trend toward miniaturization in endourological stone therapy. Good visibility, intrarenal pressures and temperature control should be ensured by ureteral sheaths. In the context of the present study, 10/12 Charr. sheaths and 12/14 Charr. sheaths for flexible ureterorenoscopy were investigated regarding stone-free rate, complication rate and efficacy for laser lithotripsy.

Methods: From January 2020 to January 2022, 100 patients each with kidney stone up to 1.5 cm in diameter were included in the study. Use of a 12/14 Charr. vs. 10/12 Charr. ureteral sheath for flexible ureterorenoscopy was compared. Perioperative data, stone size, volume and density, laser energy, laser duration, stone-free rates and complications based on Clavien-Dindo classification were retrospectively analyzed.

Results: For both groups of ureteral access sheaths, there were no differences in median surgery duration (10/12 Charr: 29 min (7-105 min) vs. 12/14 Charr: 34 min (9-95 min); p = 0.33), overall complication rate (p = 0.61) and hospitalization (p = 0.155). There were no differences in stone-free rates (97.9% vs. 92.7%, p = 0.37). Laser lithotripsy duration usingholmium laser was 1.9 min (0.1-10.8 min) vs. 3.8 min (0.2-20.7 min) (p < 0.01) and applied laser energy was 3.1 J (0.15 J-10.29 J) vs. 6.8 J (1.07 J-26.77 J) (p < 0.01) for 12/14 Charr. sheaths and 10/12 Charr. sheaths, respectively.

Conclusion: In terms of stone-free rates, there are no differences between the 10/12 and 12/14 Charr. ureteral access sheaths. The laser duration and energy was increased with 10/12 Charr. sheaths without showing increased risk for clinical complications like trauma or inflammation.

Keywords: Laser energy; Laser lithotripsy; Ureteral access sheath; Ureterorenoscopy; Urolithiasis.