Flexible ureteroscopy without ureteral access sheath

Ureteral access sheath (UAS) is widely used in flexible ureteroscopy and laser lithotripsy (FURS) based on better stone-free rates, lower intrarenal pressure and fewer complications. However, it also rises surgical costs and may injure the ureteral wall. The main objective of our study is to compare safety and efficacy of FURS with and without UAS to evaluate whether its use is justified in all cases.We performed a retrospective observational analytic study based on a prospective database. A total of 241 consecutive patients who underwent FURS for upper ureter and renal stones between January 2018 and May 2020 were included for analysis and divided into two groups upon UAS use. We compared demographic data, stone characteristics, prestenting, operative time, need for ureteral stent, postoperative urinary tract infection, renal colic and need for ancillary procedures.A total of 198 patients (82.2%) were included in the group without UAS. Operative time was significantly shorter in the group of patients without UAS than those with UAS (64.6 minutes ± 29.5 vs. 89.9 minutes ± 2.8 respectively; p 0.010). Both groups had similar rates of colic pain and urinary tract infection. Ancillary procedures were more frequent in the UAS group (37.2 vs. 21.2%; p 0.026), but significance was lost in multivariate assessment.FURS without UAS seems to be as safe as FURS with UAS but requires less ancillary procedures. An additional advantage is shorter operative time.