The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after Ureteroscopy

No AccessJournal of UrologyAdult Urology1 Nov 2020The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after Ureteroscopy John L. Cooper, Nathaly François, Michael W. Sourial, Hiroko Miyagi, Justin R. Rose, John Shields, Nitin Sharma, Paula Domino, Brandon Otto, Geoffrey N. Box, Vincent G. Bird, Tasha Posid, and Bodo E. Knudsen John L. CooperJohn L. Cooper Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , Nathaly FrançoisNathaly François Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , Michael W. SourialMichael W. Sourial Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , Hiroko MiyagiHiroko Miyagi College of Medicine, The Ohio State University Medical Center, Columbus, Ohio , Justin R. RoseJustin R. Rose Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , John ShieldsJohn Shields Department of Urology, University of Florida, Gainesville, Florida , Nitin SharmaNitin Sharma Department of Urology, University of Florida, Gainesville, Florida , Paula DominoPaula Domino Department of Urology, University of Florida, Gainesville, Florida , Brandon OttoBrandon Otto Department of Urology, University of Florida, Gainesville, Florida , Geoffrey N. BoxGeoffrey N. Box Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , Vincent G. BirdVincent G. Bird Department of Urology, University of Florida, Gainesville, Florida , Tasha PosidTasha Posid *Correspondence: The Ohio State University Wexner Medical Center, Department of Urology, 915 Olentangy River Rd., Columbus, Ohio 43212 telephone: 614-685-6657; E-mail Address: [email protected] Department of Urology, The Ohio State University Medical Center, Columbus, Ohio , and Bodo E. KnudsenBodo E. Knudsen Department of Urology, The Ohio State University Medical Center, Columbus, Ohio View All Author Informationhttps://doi.org/10.1097/JU.0000000000001147AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ureteral access sheaths are commonly used during ureteroscopy to facilitate stone removal, improve visibility and maintain low intrarenal pressures. However, the use of a ureteral access sheath can cause ureteral wall ischemia and ureteral tears, potentially increasing the risk of postoperative ureteral stricture and obstruction. We studied the impact of ureteral access sheath use on postoperative imaging studies. Secondary objectives included studying the impact of other intraoperative parameters on postoperative imaging studies. Materials and Methods: A retrospective chart review was conducted of cases that underwent ureteroscopy for nephroureterolithiasis across 2 high volume institutions between January 2012 and September 2016. Patient demographics, cumulative stone size, operative time, use of ureteral access sheath, laser lithotripsy, basket extraction, preoperative ureteral stent and postoperative ureteral stent placement were extracted from the electronic medical record. Findings of followup renal ultrasound, kidney-ureter-bladder x-ray and/or computerized tomography at approximately 8 weeks after surgery were recorded. Results: A total of 1,332 ureteroscopies were performed with 1,060 cases (79.6%) returning for routine upper tract imaging after ureteroscopy. Postoperative hydronephrosis was noted following 127 cases (12.0%). Factors predicting presence of hydronephrosis after ureteroscopy include lower body mass index (p=0.0016), greater cumulative stone size (p=0.0003), increased operative time (p <0.0001), preoperative ureteral stent (OR 1.49, p=0.0299) and postoperative ureteral stent placement (OR 6.43, p=0.0031). Postoperative hydronephrosis was not associated with use of ureteral access sheath, age, laser lithotripsy or basket extraction. Conclusions: Use of ureteral access sheath did not have a significant impact on development of postoperative hydronephrosis, suggesting ureteral access sheath is safe for use during ureteroscopy. Ureteral strictures remain rare following ureteroscopy, seen in only 1.0% of our cohort. With an observed prevalence of hydronephrosis of 12.0% on followup imaging at 8 weeks, routine upper tract imaging after ureteroscopy remains a valuable prognostic tool. References 1. : Complications of ureteroscopy: analysis of predictive factors. J Urol 2001; 166: 538. 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Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1104 and 1105. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 5November 2020Page: 976-981 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsureteral calculiureteroscopyhydronephrosiskidney calculiureterMetricsAuthor Information John L. Cooper Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Nathaly François Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Michael W. Sourial Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Hiroko Miyagi College of Medicine, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Justin R. Rose Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author John Shields Department of Urology, University of Florida, Gainesville, Florida More articles by this author Nitin Sharma Department of Urology, University of Florida, Gainesville, Florida More articles by this author Paula Domino Department of Urology, University of Florida, Gainesville, Florida More articles by this author Brandon Otto Department of Urology, University of Florida, Gainesville, Florida More articles by this author Geoffrey N. Box Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Vincent G. Bird Department of Urology, University of Florida, Gainesville, Florida More articles by this author Tasha Posid Department of Urology, The Ohio State University Medical Center, Columbus, Ohio *Correspondence: The Ohio State University Wexner Medical Center, Department of Urology, 915 Olentangy River Rd., Columbus, Ohio 43212 telephone: 614-685-6657; E-mail Address: [email protected] More articles by this author Bodo E. Knudsen Department of Urology, The Ohio State University Medical Center, Columbus, Ohio More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1104 and 1105. Advertisement PDF DownloadLoading ...