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Hyun, Song, Kim, and Jung: Efficacy of Ureteroscopic Removal of Stones with an Ureteral Access Sheath for the Treatment of Ureteral Calculi
Original Article
Endourology/Urolithiasis
Korean Journal of Urology

Korean Journal of Urology 2009; 50(4): 355-360.

Published online: 27 April 2009

DOI: https://doi.org/10.4111/kju.2009.50.4.355

Efficacy of Ureteroscopic Removal of Stones with an Ureteral Access Sheath for the Treatment of Ureteral Calculi

Chang Ho Hyun, Phil Hyun Song, Hyun Tae Kim, Hee Chang Jung

Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.

Correspondence to: Hee Chang Jung. Department of Urology, College of Medicine, Yeungnam University, 317-1, Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea. TEL: 053-620-3692, FAX: 053-627-5535, junghc@ynu.ac.kr

Received 17 December 2008       Accepted 24 February 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

The ureteral access sheath (UAS) was developed to facilitate difficult ureteroscopic procedures. However, some have questioned the safety of the UAS and its likelihood of causing significant ureteral traumas. We evaluated the efficacy and safety of a UAS for managing ureteral calculi.

Materials and Methods

From July 2005 to June 2008, a total of 122 patients underwent ureteroscopic removal of stones (67 patients with UAS, 55 patients without UAS). Under local, spinal, or general anesthesia, all patients were treated by using a semirigid ureteroscope with or without UAS. The operative results of the patients were assessed with KUB, and excretory urography or ultrasonography were assessed postoperatively after 2 to 4 weeks. We also analyzed the success rates of stone removal and the complication rates for each procedure.

Results

Mean stone size and mean operation time were 9.3 mm and 38.8 minutes, respectively, with UAS and 8.9 mm and 40.4 minutes, respectively, without UAS. Overall stone-free rates were 89.6% and 76.4%. Mean hospital stay was 2.0 days and 2.2 days. The time for operation was significantly decreased for upper ureteral stones treated with UAS (p=0.022). The stone-free rates were higher for upper ureteral stones treated with UAS (28/32, 87.5%, p=0.027), especially for stones greater than 10 mm in size (p=0.048).

Conclusions

The use of UAS is effective and safe. The stone-free rates of ureteroscopic removal of stones with UAS were significantly higher than the rates without UAS for large (≥10 mm) upper ureteral calculi.

Keywords: Ureteral calculi, Ureteroscopy, Equipment and supplies

Figures and Tables

Fig. 1
Ureteral access sheath. Applied Forté® AxP (Rancho Santa Margarita, USA). (A) 14/16 Fr. 35 cm ureteral access sheath consisting of a two-piece device: an inner tapered obturator, an outer working sheath, and a funnel-shaped ergonomic entry port. (B) The inner obturator extended beyond the 16 Fr. outer working sheath.
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Fig. 2
Fluoroscopy showing the access sheath in the right midureter with the ureteroscope inserted alongside the guidewire.
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Table 1
Characteristics of the patients
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UAS: ureteral access sheath

Table 2
Perioperative results
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UAS: ureteral access sheath, No: number, OP: operation, a: p<0.05

Table 3
Stone free rates according to the locations of the stones
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UAS: ureteral access sheath, SFR: stone free rates, a: p<0.05

Table 4
Stone free rates according to the locations and sizes of the stones
kju-50-355-i004

UAS: ureteral access sheath, SFR: stone free rates, a: p<0.05

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