Use of a ureteral access sheath (UAS) during flexible ureteroscopy to remove stones is safe and does not significantly decrease stone-free rates compared with not using a UAS, according to a new study.

Bhaskar K. Somani, FRCS (Urol), of University Hospital Southampton NHS Foundation Trust in Southampton, UK, and colleagues prospectively studied 338 patients who underwent flexible ureteroscopy for renal stones. Of these, 203 patients (60%) had UAS placement (group 1) and 135 (40%) did not (group 2).

No intraoperative complications occurred in either group, the investigators reported in the World Journal of Urology. Postoperative complications occurred in 4% of patients in group 1 and 1.5% of patients in group 2, a nonsignificant difference between the groups. The stone-free rates did not differ significantly between groups 1 and 2 (88% and 94%, respectively). Pre- and postoperative stent insertion rates were similar for groups 1 and 2.

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Procedural time was significantly longer in group 1 than group 2 (mean 54.8 vs 41.3 minutes).

Compared with group 2, group 1 had a significantly larger mean stone size (16.5 vs 11.37 mm) and larger mean number of stones (2.17 vs 1.66).

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Dr Somani’s team noted that worldwide UAS use has increased over the past decade, but questions remain regarding the safety and outcomes associated with its use.

The authors stated that, to their knowledge, their study is the largest single-center prospective study examining the outcome of flexible ureteroscopy for renal stones with and without UAS use.


Lima A, Reeves T, Geraghty R, et al. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol. 2019; doi: 10.1007/s00345-019-02878-5