The argument against the routine use of ureteral access sheaths.

The current authors' experience with thousands of ureteroscopic procedures has led them to believe that ureteral access sheaths are seldom necessary. No study to date has accurately determined an advantage of using these sheaths for routine ureteroscopy. The current authors have outlined their alternative methods that eliminate the reported advantages of the sheaths. Their philosophy of stone treatment uses laser lithotripsy for small stone burdens and SWL or PNL for larger stone burdens and eliminates the need for prolonged ureteroscopic procedures. Several disadvantages of access sheaths are evident. When this information is taken into account, the routine use of a ureteral access sheath becomes unnecessary. It is only in unusual cases that ureteral access sheaths are of any utility.