Ureteral access sheaths in RIRS: a retrospective, comparative, single-center study

Objectives: To evaluate the use of ureteral access sheaths (UAS) in reducing operative time and complications, as well as improving stone-free rates (SFR), while assessing their overall safety and efficiency. Methods: Data regarding 234 patients who underwent retrograde intrarenal surgery (RIRS) for stones up to 3cm between January 2017 and March 2020 were retrospectively analyzed. About 52.5% of procedures were performed utilizing a UAS. Differences in operative time, fluoroscopy time, stone-free rate, and complications were analyzed between procedures with and without UAS and stratified, according to stone burden size, into three groups (Group A: 0.5-1cm; Group B: 1-2cm; Group C: 2-3cm). Results: Operative time, fluoroscopy time, and residual fragments size were lower in RIRS without UAS, respectively, 54.27 ± 24.02 vs. 62.23 ± 22.66min (p=0.010), 2.72 ± 0.89 vs. 4.44 ± 1.67min (p<0.0001), and 3.85 ± 0.813 vs. 4.60 ± 0.83mm (p=0.011). Considering stone burden, operative time was lower in RIRS without UAS for Group A (36.40 ± 8.555 vs. 46.05 ± 6.332min) (p<0.0001) while higher for Group B (60.39 ± 18.785 vs. 50.14 ± 5.812min) (p=0.002). Similarly, fluoroscopy time was lower in RIRS without UAS in every group, respectively, 2.11 ± 0.34 vs. 2.74 ± 0.57min (p<0.0001), 2.94 ± 0.51 vs. 4.72 ± 0.37min (p<0.0001), and 3.78 ± 1.26 vs. 6.79 ± 1.17min (p<0.0001). Only Group C had a statistically significant difference in residual fragment size without UAS (3.89 ± 0.782 vs. 4.75 ± 0.886mm) (p=0.050). Conclusions: UAS should be carefully evaluated considering the increased fluoroscopy time and the differences in operative time related to different stone burdens.