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Is Access Sheath Essential for Safety and Effective Retrograde Intrarenal Stone Surgery?

OBJECTIVE
To evaluate the results of retrograde intrarenal surgery (RIRS) with flexible ureteroscope (f-URS), using ureteral access sheath and without the sheath.


STUDY DESIGN
Descriptive study. Place and Duration of the Study: Kesan State Hospital, Edirne, Turkey, between February 2019 and May 2020.


METHODOLOGY
Patients treated with RIRS for renal and proximal ureteral stone were evaluated. Two groups were formed that used ureteral access sheath or not. Operation and fluoroscopy times, postoperative complications and stone-free rates were compared.


RESULTS
Group 1 consisted of 51 patients were operated with, using ureteral access sheath; and Group 2 having 62 patients, were operated without using ureteral access sheath. The mean volume of the stones was 1135 mm3 (73-7491 mm3) in the group without access sheath and 1273 mm3 (251-3635 mm3) in the group with access sheath. The mean operation time was 55 minutes (20-115 min) in the group without access sheath, and 70 minutes (30-125 min) in the group with access sheath. Postoperative febrile UTI was found in 5 (8%) of the patients without access sheath, and in 4 (8%) of the patients with access sheath (p=0.733). The stone-free rate of the patients with radiological controls was 58 (93%) in the group without access sheath and 46 (90%) in the group with access sheath (p=0.306). Fluoroscopy timings were 2.7 seconds (0-8 sec) in the group without access sheath and 8.4 seconds (2-20 sec) in the group with access sheath (p=0.001).


CONCLUSION
UAS usage has no marked impact on SFR, complication rate and operation time. RIRS can be performed safely and effectively without using UAS. Key Words: Flexible ureteroscope, ITO score, Ureteral access sheath, Intrarenal stones.