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Victor DR, Oliveira RDAPD, Melão BVLA, Coelho HGB, Barros Júnior TDP. Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis. J Endourol 2024. [PMID: 38757611 DOI: 10.1089/end.2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Ureteral access sheath (UAS) use during ureteroscopy has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents as a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. METHODS A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies that compared preoperative α1-blockers administration versus its non-use in adult patients without pre-stenting undergoing ureteroscopy. Binary outcomes were evaluated using risk ratios (RR) and odds ratios (OR) with 95% confidence intervals. Heterogeneity was measured with the Cochran Q test, I2 statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes. RESULTS Eleven studies encompassing 1074 patients undergoing ureteroscopy were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; I²=6%; PI 0.10-0.88) and an increase in mean successful ureteral access sheath insertion (OR 2.14; 95% CI 1.08-4.23; I²=23%; PI 0.51-8.93). In patients undergoing ureteroscopy lithotripsy, the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; I²=0%), and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; I²=0%). No significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; I²=91%; PI 0.47-2.59). CONCLUSION Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during ureteroscopy lithotripsy procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in patients undergoing ureteroscopy with UAS is advisable.
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Affiliation(s)
- David Romeiro Victor
- Universidade de Pernambuco, Faculty of Medical Sciences, Recife, Pernambuco, Brazil;
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Lavasani SAM, Rojhani A, Cumpanas AD, Osann K, Morgan KL, Hernandez MC, McCormac A, Piedras P, Vo K, Gorgen ARH, Sharifi SHH, Gao BM, Tano ZE, Patel RM, Landman J, Clayman RV. Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury. J Endourol 2024; 38:316-322. [PMID: 38243836 DOI: 10.1089/end.2023.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants).
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Affiliation(s)
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kathryn Osann
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mariah C Hernandez
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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O’Meara S, Croghan S, O’Brien FJ, Davis NF. A Good Craftsperson Knows Their Tools: Understanding of Laser and Ureter Mechanics in Training Urologists. J Lasers Med Sci 2023; 14:e29. [PMID: 37744011 PMCID: PMC10517579 DOI: 10.34172/jlms.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 09/26/2023]
Abstract
Introduction: Recent decades have seen a move to minimally invasive techniques to manage urolithiasis. Trainees are expected to develop competency in common endourology procedures. Knowledge of ureter mechanics and the theory behind new technologies is important to ensure safe and efficient techniques. We aim to evaluate the exposure to endourology, self-reported competency in common techniques and knowledge of basic ureter biomechanics and technology in training urologists. Methods: An online survey was circulated to all training urologists in the Republic of Ireland. Questions focused on self-reported competency, clinical knowledge, ureter mechanical properties and laser technology. Results: Thirty responses were received with a range of 1-8 years of urology experience (mean=4 years). The respondents reported high levels of exposure to endourology with the majority reporting competency in flexible ureterorenoscopy (FURS) (n=18, 60%) and semi-rigid ureteroscopy (URS) (n=21, 70%). The respondents demonstrated good clinical knowledge but variable knowledge of laser settings, laser thermodynamics and ureter mechanics. Half of the respondents (n=15, 50%) correctly described fragmentation laser settings, with 10 trainees (n=33%) accurately identifying both factors that increase ureteral access sheath (UAS) insertion force. Most of the respondents (n=20, 67%) described the proximal ureter as the site with the greatest compliance, while the site of the greatest force during ureteroscope insertion was correctly identified by 17% (n=5). Conclusion: To our knowledge, this represents the first study evaluating urologist understanding of laser technology and the mechanical properties of the human ureter. Despite trainees reporting high levels of experience in endourology, there is a variable understanding of the principles of laser technology and ureter mechanics. Further research and education are needed with a focus on laser safety, suitable laser settings and the safe limit of insertion forces.
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Affiliation(s)
- Sorcha O’Meara
- Department of Surgery, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Stefanie Croghan
- Department of Surgery, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Fergal J. O’Brien
- Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Niall F. Davis
- Department of Surgery, Royal College of Surgeons of Ireland, Dublin, Ireland
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
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Ozimek T, Dellas P, Becker B, Miernik A, Roesch MC, Merseburger AS, Kramer MW, Wießmeyer JR. The Role of 12/14F Ureteral Access Sheath in Flexible Ureteroscopy for Moderate Nephrolithiasis. Aktuelle Urol 2023. [PMID: 36918150 DOI: 10.1055/a-2024-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The aim was a retrospective analysis of 12/14F ureteral access sheath (UAS) usage on perioperative outcomes in patients with moderate nephrolithiasis (MN). MN was defined as a maximum of two unilateral kidney stones with a maximum stone diameter of 6-10 mm. MATERIAL AND METHODS We conducted a monocentric retrospective univariate and multivariate analysis of flexible ureteroscopies (fURS) performed for MN between 01/2014 and 12/2018. RESULTS A total of 402 fURS were performed in patients with urolithiasis; 112 MN cases underwent further analysis. UAS was successfully applied in 33 MN cases [33/112 (29.46%)]. UAS was inserted regardless of the maximum kidney stone diameter and the presence of multiple kidney stones (p > 0.05). Univariate analysis revealed a prolonged median operation time (UAS: 94 min, non-UAS: 74 min, p = 0.04) and median fluoroscopy time (UAS: 75 s, non-UAS: 57.5 s, p = 0.04) in the UAS cohort. These differences were not confirmed on multivariate logistic regression.UAS was not associated with better stone-free rates in either the univariate or multivariate analysis (UAS: 26/33, non-UAS: 61/79, p = 1.0) nor with the occurrence of Clavien-Dindo ≥2 complications (UAS: 3/33, non-UAS: 9/79, p = 0.98) or median length of hospital stay (UAS: 2 days, non-UAS: 2 days, p = 0.169). CONCLUSION We identified no statistical benefits from the usage of 12/14F UAS for MN. As no relevant UAS-associated complications were documented, both strategies (with and without UAS) are feasible.
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Affiliation(s)
- Tomasz Ozimek
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Pauline Dellas
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Marie Christine Roesch
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | | | - Mario Wolfgang Kramer
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
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Ostergar A, Wong D, Shiang A, Ngo S, Venkatesh R, Desai A, Sands K. Intrarenal Pressure with Vacuum-Assisted Ureteral Access Sheaths Using an In Situ Cadaveric Porcine Model. J Endourol 2023; 37:353-357. [PMID: 36355600 DOI: 10.1089/end.2022.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Vacuum-assisted ureteral access sheaths (V-UASs) are a new tool designed to evacuate dust or small fragments during retrograde intrarenal surgery (RIRS). There are reports of increased stone-free rates, decreased infections, and decreased operative time with V-UAS usage. The optimal technique and setting for V-UAS has yet to be described. Herein, we investigate real-time intrarenal pressure (IRP) throughout a range of settings using V-UAS in a porcine RIRS model. Materials and Methods: Ureteroscopy was performed in three female porcine cadaver kidneys through a ClearPetra V-UAS. IRP was recorded through a percutaneous catheter at different inflow pressures, sheath sizes, sheath distance from the ureteropelvic junction, and suction settings. Magnitude of change in delta IRP (dIRP) was compared at various settings. Results: There was no statistical difference in IRP when comparing no suction with vent inactivated. As expected, IRP decreased with larger sheath size and lower irrigation pressures. Average IRP dropped ∼18 mm Hg with suction activation (42.30 mm Hg, vent inactivated; 24.45 mm Hg IRP, suction activated; p < 0.0001). Irrigation pressure and sheath size did not make a difference in the dIRP. dIRP was significantly greater at lower suction settings compared with max suction (25.44 dIRP at 200 mm Hg suction, 10.26 mm Hg dIRP at max suction, p = 0.04). In a subset of observations, IRP paradoxically increased to higher than IRP with no suction at all after >5 seconds of activated suction. Conclusion: Use of V-UAS during RIRS can lower mean IRP; however, this effect could reverse with extended suctioning especially under conditions of high vacuum (>200 mm Hg) owing to outflow tract collapse. Our results suggest urologists should use lower suction settings and short, <5-second bursts to maximize therapeutic benefit, and minimize potential shortcomings of V-UAS during RIRS.
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Affiliation(s)
- Adam Ostergar
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Daniel Wong
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Alex Shiang
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Steven Ngo
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Alana Desai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kenneth Sands
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
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Juliebø-Jones P, Keller EX, Haugland JN, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST). JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Øyvind Ulvik
- Department of Clinical Medicine, University of Bergen, Norway
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Ozimek T, Wiessmeyer JR, Struck JP, Roesch MC, Gilbert N, Laturnus JM, Merseburger AS, Kramer MW. The dilemma of 12/14F ureteral access sheath (UAS) usage: a case control study. BMC Urol 2022; 22:84. [PMID: 35705924 PMCID: PMC9199145 DOI: 10.1186/s12894-022-01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The insertion of a ureteral access sheath (UAS) is a frequent procedure during flexible ureteroscopy (fURS) to facilitate kidney stone treatment. The aim of this study was to investigate the influence of 12/14 French (F) UAS on fURS outcomes. METHODS We performed a retrospective monocentric analysis of fURS procedures conducted at the Department of Urology (University Hospital Schleswig-Holstein, Lübeck, Germany) for kidney stone treatment via lithotripsy or basket stone retrieval between September 2013 and June 2017. Uni- and multivariate analyses were done with the help of RStudio (Version 1.0.136) software. RESULTS In total, 283 consecutive fURS were analyzed. UAS was applied in 98 cases (34.63%). The insertion of UAS was preferred in cases with multiple kidney stones and larger median maximal stone diameter (p < 0.05). UAS usage correlated with elevated radiation exposure in seconds (94 vs. 61; p < 0.0001), prolonged operation time in minutes (99 vs. 66, p < 0.0001), length of hospital stay over 48 h (LOS, 22.49% vs. 10.81%; p = 0.015), more frequent postoperative systemic inflammatory response syndrome (SIRS, 13.27% vs. 4.32%; p = 0.013) and lower postoperative stone-free rates (60.20% vs. 78.92%; p = 0.0013). Moreover, we conducted uni- and multivariate subgroup analysis for cases with multiple kidney stones (≥ 2) and comparable stone burden; UAS was inserted in 48.3% of these cases (71/147). On multivariate logistic regression, UAS insertion was statistically associated with prolonged operation time in minutes (101 vs. 77; p = 0.004). No statistical differences regarding radiation exposure, stone-free rates, postoperative SIRS rates or LOS were noted between UAS and non-UAS patients with multiple kidney stones of similar size (p > 0.05). CONCLUSIONS 12/14F UAS does not seem to improve overall outcomes in fURS for kidney stones. In patients with multiple kidney stones it may be associated with elevated operation time without a clear benefit in terms of improved stone-free status or reduced perioperative complication rate. Further prospective randomized studies to specify the indications for UAS usage are urgently needed.
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Affiliation(s)
- Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Judith R Wiessmeyer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Julian P Struck
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marie C Roesch
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Nils Gilbert
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jan M Laturnus
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Mario W Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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Hu J, Yu Y, Liu W, Zhong J, Zhou X, Xi H. Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement. Int J Clin Pract 2022; 2022:7518971. [PMID: 36120665 PMCID: PMC9467721 DOI: 10.1155/2022/7518971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. METHODS We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. RESULTS Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p=0.013), length of history 15-31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p=0.045), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p=0.023), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p=0.035) were associated with UAS placement. CONCLUSION Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.
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Affiliation(s)
- Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialei Zhong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Raskolnikov D, Harper JD. When the sheath hits the fan: an argument against the routine use of ureteral access sheaths. J Endourol 2021; 36:584-587. [PMID: 34963314 DOI: 10.1089/end.2021.0860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dima Raskolnikov
- University of Washington School of Medicine, 12353, Department of Urology, 1959 NE Pacific St, Box 356510, Seattle, Washington, United States, 98195-6340;
| | - Jonathan D Harper
- University of Washington School of Medicine, 12353, Department of Urology, Seattle, Washington, United States;
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Wong VK, Aminoltejari K, Almutairi K, Lange D, Chew BH. Controversies associated with ureteral access sheath placement during ureteroscopy. Investig Clin Urol 2021; 61:455-463. [PMID: 32869562 PMCID: PMC7458869 DOI: 10.4111/icu.20200278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
The use of ureteral access sheaths (UAS) is common practice during routine flexible ureteroscopy procedures. However, debates and concerns continue amongst endourologists on routine UAS placement. UAS placement allows for multiple passages of the ureteroscope, decreases intrarenal pressure, and may improve stone-free rates. However, concerns for the UAS's effectiveness in these claimed benefits and complications related to UAS placement has been documented and investigated by many. In this review, we will discuss the controversies surrounding the placement of UAS during ureteroscopy.
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Affiliation(s)
- Victor Kf Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Khatereh Aminoltejari
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Khaled Almutairi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Pietropaolo A, Bres-Niewada E, Skolarikos A, Liatsikos E, Kallidonis P, Aboumarzouk O, Tailly T, Proietti S, Traxer O, Giusti G, Rukin N, Özsoy M, Talso M, Emre ST, Emiliani E, Atis G, Somani BK. Worldwide survey of flexible ureteroscopy practice: a survey from European Association of Urology sections of young academic urologists and uro-technology groups. Cent European J Urol 2019; 72:393-397. [PMID: 32015909 PMCID: PMC6979553 DOI: 10.5173/ceju.2019.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction To understand the current practice of flexible ureteroscopy (fURS), we conducted a worldwide survey among urologists with a special interest in endourology. Material and methods A 42-question survey was designed after an initial consultation with European Association of Urology young academic urologists (YAU) and uro-technology (ESUT) groups. This was distributed via the SurveyMonkey® platform and an ESUT meeting to cover practice patterns and techniques in regard to ureteroscopy usage worldwide. Results A total of 114 completed responses were obtained. A safety guidewire was reportedly used by 84.5% of endourologists, an access sheath was always or almost always used by 71% and a reusable laser fibre was used by two-thirds of respondents. While a combination of dusting and fragmentation was used by 47% as a preferred mode of intra-renal stone treatment, some used dusting (43%) or fragmentation with basketing (10%). Disposable scopes were only used by 40% and three quarters of them used it for challenging cases only. Antibiotic prophylaxis was limited to a single peri-operative dose by two-thirds (67%) of respondents. The procedural time was limited to between 1–2 hours by two-thirds (70%) of respondents and very rarely (7.4%) it exceeded 2 hours. The irrigation method varied between manual pump (46%), mechanical irrigation (22%) or gravity irrigation (27%). Conclusions Our survey shows a wide variation in the available endourological armamentarium and surgical practice amongst urologists. However, there seems to be a broad agreement in the use of peri-operative antibiotics, access sheath usage, method of stone treatment and the use of post-operative stent.
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Affiliation(s)
- Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom
| | - Ewa Bres-Niewada
- Roefler Memorial Hospital, Department of Urology, Pruszków, Poland
| | | | | | | | - Omar Aboumarzouk
- NHS Greater Glasgow and Clyde, Department of Urology, Glasgow, United Kingdom
| | - Thomas Tailly
- Universitair Ziekenhuis Gent, Department of Urology, Gent, Belgium
| | - Silvia Proietti
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Department of Urology, Milan, Italy
| | - Oliver Traxer
- Tenon Hospital, Assitance Publique-Hopitaux De Paris, Pierre et Marie Curie University, Department of Urology, Paris, France
| | - Guido Giusti
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Department of Urology, Milan, Italy
| | - Nick Rukin
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Mehmet Özsoy
- Medical University of Vienna, Vienna General Hospital, Department of Urology, Vienna, Austria
| | - Michele Talso
- ASST Vimercate Hospital, Department of Urology, Vimercate, Monza Brianza, Italy
| | | | | | - Gokhan Atis
- Istanbul Medeniyet University, Department of Urology, Istanbul, Turkey
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom.,University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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