Dose A ureteral access sheath facilitate ureteroscopy?

Purpose: Ureteral access sheaths were initially developed to facilitate dif ficult ureteroscopic access. However, to our knowledge no formal evaluation s have been performed to assess the routine use of ureteral access sheaths. Therefore, we prospectively analyzed intraoperative time, symptomatic outc ome, major complications, stone-free rate and overall costs related to the routine use of a new ureteral access sheath during standard ureteroscopic p rocedures. Materials and Methods: Patients undergoing 6.5Fr semirigid or 7.5Fr flexibl e ureteroscopy were prospectively randomized to unaided ureteroscopy with n o access sheath or ureteroscopy via a 12-14Fr ureteral access sheath. Patie nts who required ureteral dilatation were randomized to the ureteral access sheath used as a dilator or a standard 18Fr ureteral balloon dilator. Pati ents were evaluated postoperatively on days 0, 1 and 6 with a questionnaire to assess pain, irritative symptoms and complications. The stone-free rate and long-term complications were determined by excretory urography or comp uterized tomography at 3 months. Results: Enrolled in the study were 59 consecutive patients, who underwent a total of 62 ureteroscopic procedures. Of the 47 patients (76%) who did no t require ureteral dilatation 23 (49%) underwent ureteroscopy via the urete ral access sheath and 24 (51%) underwent unaided ureteroscopy. Seven of the 15 patients (28%) who required ureteral dilatation underwent access sheath dilatation, while balloon dilatation was performed in 8. There was no sign ificant difference in postoperative symptoms, complication rate or stone-fr ee status in the access sheath and nonaccess sheath groups in patients not requiring ureteral dilatation (p <0.05). A significant increase in postoper ative symptoms was noted when the balloon was used as a dilator compared to the access sheath. Operative time and costs in all patients who underwent access sheath dilatation were less than in those in whom the access sheath was not used. In the 15 patients who required dilatation 71% of access shea th and 100% of balloon dilatations were successful. Conclusions: Routine use of a ureteral access sheath appears to facilitate semirigid and flexible ureteroscopy by decreasing operative time and costs, allowing direct visualization of ureteroscope insertion with simple ureter al re-entry and assisting renal and ureteral access with minimal associated morbidity. A ureteral access sheath should be considered for routine urete roscopic procedures.