Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Oktay Özman; Hacı M Akgül; Cem Başataç; Önder Çınar; Eyüp B Sancak; Cenk M Yazıcı; Bülent Önal; Haluk Akpınar; RIRSearch Study Group

doi:10.1016/j.ajur.2021.11.004

Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Asian J Urol. 2024 Jan;11(1):80-85. doi: 10.1016/j.ajur.2021.11.004. Epub 2021 Nov 20.

Authors

Oktay Özman¹, Hacı M Akgül², Cem Başataç³, Önder Çınar⁴, Eyüp B Sancak⁵, Cenk M Yazıcı², Bülent Önal⁶, Haluk Akpınar³; RIRSearch Study Group

Affiliations

¹ Gaziosmanpasa Training and Research Hospital, Urology Clinic, İstanbul, Turkey.
² Tekirdağ Namık Kemal University, School of Medicine, Department of Urology, Tekirdağ, Turkey.
³ Group Florence Nightingale Hospitals, Department of Urology, İstanbul, Turkey.
⁴ Zonguldak Bulent Ecevit University, School of Medicine, Department of Urology, Zonguldak, Turkey.
⁵ Çanakkale Onsekiz Mart University, School of Medicine, Department of Urology, Çanakkale, Turkey.
⁶ İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Urology, İstanbul, Turkey.

Abstract

Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS).

Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [⁺] 87 and UAS non-used [^-] 87 patients). Then all UAS⁺ patients (n=481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS.

Results: Stone-free rate of UAS⁺ patients (86.2%) was significantly higher than UAS^- patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p<0.001). Postoperative complications of UAS⁺ patients (11.5%) were significantly lower than UAS^- patients (27.6%) (p=0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively).

Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.

Keywords: Kidney; Retrograde intrarenal surgery; Stone; Ureteral access sheath; Urolithiasis.