Prospective Evaluation and Classification of Ureteral Wall Injuries Resulting from Insertion of a Ureteral Access Sheath During Retrograde Intrarenal Surgery

No AccessJournal of UrologyAdult Urology1 Feb 2013Prospective Evaluation and Classification of Ureteral Wall Injuries Resulting from Insertion of a Ureteral Access Sheath During Retrograde Intrarenal Surgery Olivier Traxer and Alexandre Thomas Olivier TraxerOlivier Traxer Equal study contribution. Financial interest and/or other relationship with Coloplast, Socomed/Rocamed and American Medical Systems. More articles by this author and Alexandre ThomasAlexandre Thomas Equal study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.197AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The safety of using a ureteral access sheath during retrograde intrarenal surgery remains controversial. Using a novel classification, we prospectively evaluated the incidence and severity of ureteral access sheath driven ureteral wall injury after flexible ureteroscopy for retrograde intrarenal surgery. Materials and Methods: Data on a total of 359 consecutive patients who underwent retrograde intrarenal surgery for kidney stone were prospectively collected at 2 academic centers. We propose what is to our knowledge a novel endoscopic classification of iatrogenic ureteral wall injury. Ureteral injuries after retrograde intrarenal surgery were assessed visually with a digital flexible ureterorenoscope. The primary outcome measure was the incidence and nature of ureteral injuries. We sought factors predisposing to such injuries. Results: Ureteral wall injury was found in 167 patients (46.5%). Severe injury involving the smooth muscle layers was observed in 48 patients (13.3%). Males vs females (p = 0.024) and older vs younger patients (p = 0.018) were at higher risk for severe ureteral access sheath related ureteral injury. The most significant predictor of severe injury was absent ureteral Double-J® stenting before retrograde intrarenal surgery (p <0.0001). Pre-stenting vs no pre-stenting decreased the risk of severe injury by sevenfold. Body mass index, a history of diabetes mellitus, vascular disease or abdominopelvic radiation therapy and operative time were not associated with severe ureteral injury. Conclusions: Ureteral access sheath use for retrograde intrarenal surgery should involve systematic visual assessment of the entire ureter to recognize severe ureteral injury. The incidence of severe ureteral injury is largely decreased by preoperative Double-J stenting. References 1 : Does a ureteral access sheath facilitate ureteroscopy?. J Urol2001; 165: 789. 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Link, Google Scholar Departments of Urology, Academic Hospital of Tenon, University Pierre and Marie Curie, Paris, France, and University Hospital of Liège (AT), Liège, Belgium© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHarper J, Desai A, Maalouf N, Yang H, Antonelli J, Tasian G, Lai H, Reese P, Curatolo M, Kirkali Z, Al-Khalidi H, Wessells H, Scales C, Reese P, Tasian G, Ziemba J, Funsten E, Mussell A, McCune R, Shah S, Jain A, Selman-Fermin A, Maalouf N, Antonelli J, Johnson B, Pearle M, Baker L, Piskator B, Obiaro J, Rangel C, Hill M, Harper J, Wessells H, Curatolo M, Edwards T, Sorensen M, Sweet R, Baxter T, Covert H, Ayala E, Flint L, Cho G, Marshall G, Desai A, Lai H, Du K, Mueller S, Black L, Klim A, Scales C, Al-Khalidi H, Corneli A, Reeve B, Weinfurt K, Yang H, Andersen D, Johnson L, Dodd A, Thompson O, Dombeck C, McKenna K, Swezey T, Kirkali Z and Mullins C (2023) Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTSJournal of Urology, Sunaryo P, May P, Holt S, Sorensen M, Sweet R and Harper J (2022) Ureteral Strictures Following Ureteroscopy for Kidney Stone Disease: A Population-based AssessmentJournal of Urology, VOL. 208, NO. 6, (1268-1275), Online publication date: 1-Dec-2022.Tapiero S, Kaler K, Jiang P, Lu S, Cottone C, Patel R, Okhunov Z, Klopfer M, Landman J and Clayman R (2021) Determining the Safety Threshold for the Passage of a Ureteral Access Sheath in Clinical Practice Using a Purpose-Built Force SensorJournal of Urology, VOL. 206, NO. 2, (364-372), Online publication date: 1-Aug-2021.Fulla J, Prasanchaimontri P, Rizk A, Loftus C, Remer E and Monga M (2020) Ureteral Diameter as Predictor of Ureteral Injury during Ureteral Access Sheath PlacementJournal of Urology, VOL. 205, NO. 1, (159-164), Online publication date: 1-Jan-2021.Cooper J, François N, Sourial M, Miyagi H, Rose J, Shields J, Sharma N, Domino P, Otto B, Box G, Bird V, Posid T and Knudsen B (2020) The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after UreteroscopyJournal of Urology, VOL. 204, NO. 5, (976-981), Online publication date: 1-Nov-2020.Assimos D (2019) Re: A Prospective Study Analyzing the Association between High-Grade Ureteral Access Sheath Injuries and the Formation of Ureteral StricturesJournal of Urology, VOL. 202, NO. 3, (454-454), Online publication date: 1-Sep-2019.Assimos D (2018) Re: Medical Impulsive Therapy (MIT): The Impact of 1 Week of Preoperative Tamsulosin on Deployment of 16-French Ureteral Access Sheaths without Preoperative Ureteral Stent PlacementJournal of Urology, VOL. 201, NO. 1, (25-25), Online publication date: 1-Jan-2019.Assimos D (2018) Re: Use of the Ureteral Access Sheath during Ureteroscopy: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 200, NO. 4, (692-694), Online publication date: 1-Oct-2018.Koo K, Yoon J, Park N, Lee H, Ahn H, Lee K, Kim D, Cho K, Chung B and Hong C (2018) The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled StudyJournal of Urology, VOL. 199, NO. 6, (1622-1630), Online publication date: 1-Jun-2018.Humphreys M, Shah O, Monga M, Chang Y, Krambeck A, Sur R, Miller N, Knudsen B, Eisner B, Matlaga B and Chew B (2017) Dusting versus Basketing during Ureteroscopy–Which Technique is More Efficacious? 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Volume 189Issue 2February 2013Page: 580-584 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsiatrogenic diseasewounds and injuriesureterureteroscopystentsMetricsAuthor Information Olivier Traxer Equal study contribution. Financial interest and/or other relationship with Coloplast, Socomed/Rocamed and American Medical Systems. More articles by this author Alexandre Thomas Equal study contribution. More articles by this author Expand All Advertisement PDF downloadLoading ...