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WHAT IS THE EFFECT OF SMALL SIZE URETERAL ACCESS SHEAT ON URETERAL STRICTURE DURING RETROGRADE INTRARENAL SURGERY?: A ONE-YEAR FOLLOW-UP.

Aim: To analyze the ureteral injury and incidence of ureteral stricture
in a series of patients who underwent retrograde intrarenal surgery with
using smallest ureteral access sheath. Materials and Methods: Between
September 2016 and March 2019, 154 consecutive retrograde intrarenal
surgery procedures with adjunctive use of an ureteral access sheath for
kidney stone were prospectively included the study. A 9.5/11.5-F
ureteral access sheath was used during procedures. The patients were
evaluated in terms of intraoperative postoperative and late
complications. Ureteral injuries after retrograde intrarenal surgery
were assessed visually with flexible and semirigid ureterorenoscope. All
patients were evaluated by computed tomographic urography in the first
year after treatment for detection of ureteral stricture. Results: The
mean age of the patients was 47±15 (12-81) years. Of the patients, 86
were male and 68 were female. Mean stone size was 17.1±8 (7-40) mm and
mean operative time was 56±23 (30-120) minutes. Overall 79.9% of
patients had evidence of injury to the ureter wall. Non-significant
lesion (grade 0) was seen in 39.0% of patients. Grade 1 lesions were
assigned in 40.9% of patients. There were no grade 2 and higher lesions
detected. A total of 5 patients (3.2%) had minor complications. Urinary
sepsis developed as a major complication in 3 patients (1.9%). No
ureteral stricture was detected in the patients at first year control.
Conclusions: The results of our series indicate that the 9.5/11.5-F
ureteral access sheath is safe for routine use to facilitate flexible
ureteroscopy and there was no long-term adverse effect.