Ümit YILDIRIM, Mehmet USLU, Mehmet EZER, Bumin ORS

Does the Use of an Access Sheath in Flexible Ureteroscopic Stone Surgery Affect the Stone-Free Rate in the Late Postoperative Period?

Aim: Studies indicate that a ureteric access sheath (UAS) is unnecessary for retrograde intrarenal surgery 5 (RIRS) if the surgeon enters the ureter directly. This research aims to look back on our case series in light of the existing literature and directly compare cases with and without a UAS in terms of efficacy, safety, and stone-free rates in the late postoperative period (3rd month). Materials and Methods: From January 2019 to June 2022, a retrospective screening of kidney stone cases treated with RIRS in our clinic was carried out. The study included one hundred fiftythree participants who complied with all inclusion and exclusion criteria. Group UAS was created for individuals who received UAS applications, and Group N for those who did not. The demographics, preoperative and postoperative laboratory, and radiographic data have been compared between the two groups. Results: A comparable distribution in terms of gender and age (50.85±13.20 vs. 52.84±14.27; p=0, 476) was seen between the groups. The Charlson Comorbidity Indexes were found to have a similar distribution [median (IQR): 1 (0.5–2.5) vs. 1 (0–3); p=0.986]. Serum creatinine levels (0.92±0.27 vs. 0.97±0.34; p=0, 560), fever or sepsis (0.0% vs. 1.0%; p=0, 686), and hospital stay (2.15±0.65 vs. 2.31±0.74; p=0, 691) were comparable between the groups during the surgical follow-up. Even though Group UAS was superior in the postoperative three-month stone-free assessment with computerized tomography, this difference was not statistically significant (72.9% vs. 73.3%; p=0, 552). Conclusion: In the surgical management of kidney stones, RIRS can be used safely and effectively whether or not UAS is used. Complications and success rates in the late postoperative phase (3 months) are not significantly impacted by UAS use.

Keywords:

access sheath, renal stones, retrograde intrarenal surgery,

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