Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study
Oktay Özman, Murat Akgül, Cem Başataç, Önder Çınar, Eyüp Burak Sancak, Cenk Murat Yazıcı, Bülent Önal, Haluk Akpınar
Abstract
To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone free rate and complications of retrograde intrarenal surgery (RIRS). Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [−] 87 patients). Then all UAS + patients (n = 481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS. Stone-free rate of UAS + patients (86.2%) was significantly higher than UAS− patients (70.1%) after propensity score matching (p = 0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.3%; 11–13 Fr: 91.3%; 13–15 Fr: 100%; p < 0.0001). Postoperative complications of UAS + patients (11.5%) were significantly lower than UAS− patients (27.6%) (p = 0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.3%) but was not statistically significant (p = 0.08). UAS usage was an independent factor predicting stone-free status or peri/postoperative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively). Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.