The Application of Ureteral Access Sheath in Ureteroscopy

Objective To evaluate the feasibility,efficacy and safety of ureteral access sheath treatment when ureteroscopy encounter difficulties.Methods 72 patients with ureteral stricture were selected from Department of Urology,Ningbo Urinary and Kidney Hospital during January 2011 to October 2012,of which 63 cases had ureteral stones,9 cases had hematuria or received ureteroscopy.After combined spinal and epidural anesthesia or general anesthesia,the cases were examined by ureteroscopy,when ureteroscopy encountered difficulties due to ureteral stricture,zebra guidewire was placed and ureteral access sheath was inserted to dilate the stricture slowly,persistently and helically before ureteroscope.Results 69 in 72 cases received ureteroscope successfully.2 cases who had hydronephrosis and ureterectasis were found pale ureter mucosa and stiff ureter wall,urter was hugged when dilating,in order to avoid urter injury,double J stent was indwelled,gastric adenocarcinoma was confirmed by gastroscopy and pathological examination.1 case who had renal pelvis occupying encountered ureteroscopy failure due to stiff ureter,then ureteroscopy was given up,then sick renal,whole ureter and bladder were removed,renal pelvic carcinoma was diagnosed by pathological examination.Conclusion The application of ureteral access sheath in ureteroscopy could improve success rate when ureteroscopy encounter ureteral stricture,and enhance the efficacy and safety of ureteroscopy,it is worthy of clinical expansion application.