Safety And Efficacy of Using Ureteral Access Sheath in Flexible Ureteroscopy Surgery

Background: The ureteral access sheath (UAS) is widely employed in flexible ureteroscopy (FURS) because of its high stone-free rate and low intrarenal pressure. However, it may damage the ureteral wall and raise surgical costs. Therefore, we wanted to assess the safety and efficiency of FURS with and without UAS in treating renal stones.
Objectives: This research aimed to assess the safety and useful efficacy of applying a ureteral access sheath (AS) in the operation of flexible ureteroscopy (fURS) for stone removal, concentrating on results such as complications, operation duration, and stone-free rate.
Patients and methods: Between August 2021 and August 2023, this prospective, randomized trial was carried out at Badr Hospital, and Demerdash Hospital. Patients were randomly assigned to two groups (flexible URS with AS: 66 patients and fURS without AS: 62 patients) and evaluated before and after surgery, including laboratory testing and imaging. Possible procedure-related hazards, including unsuccessful stone access, discomfort, bleeding, and infection, were monitored.
Results: Preoperative stone results and demographic factors were similar in the 2 groups (p > 0.05 for all). However, the no sheath group's operation time was lower (79.4 ± 15.3 minutes compared to 90.4 ± 16.7 minutes in the group that using access sheath, p=0.008). Both groups experienced similar rates of intraoperative complications, such as hemorrhage, ureteric damage, operation termination, and unsuccessful access (p > 0.05). There was no significant change in the mean residual stone size (2.7 ± 3.5 mm vs. 3.1±3.1 mm, p=0.687) or the postoperative results of stone-free rates (78.8% vs. 71.0%, p=0.305).
Conclusions: According to the current study, flexible URS without an access sheath may provide a practical and equally effective alternative for treating renal and upper ureteric stones.