Shields John M, Tunuguntla Hari S G R, Bhalani Vishal K, Ayyathurai Rajnikanth, Bird Vincent G
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Urology. 2009 Feb;73(2):241-4. doi: 10.1016/j.urology.2008.07.055. Epub 2008 Oct 8.
Ureteral access sheaths (UASs) are used to facilitate ureteroscopic procedures. Difficulties with use have been reported. Manufacturers have redesigned these devices to ameliorate these problems, including reinforcement of the sheath wall. This study compared reinforced (RUASs) and nonreinforced UASs (NRUASs) of the same manufacturer to determine whether RUASs expedite ureteroscopy and how relevant the reinforced structure is in terms of overall success.
We prospectively followed up patients undergoing ureteroscopy for urolithiasis with 1 of 2 UASs; the Applied NRUAS and the Applied RUAS. The demographics, operative parameters, and outcomes were assessed. Statistical analysis was performed.
A total of 98 UASs were used in 68 male and 30 female patients (47 NRUASs and 51 RUASs). No significant differences were found between the groups in terms of demographic parameters, operative parameters, or successful sheath deployment. The overall success rate for sheath deployment was 95%. A pre-existing stent was significantly associated with successful deployment (P = .004). The sheath-specific limitations included kinking (NRUASs, 10%) and sheath angulation/deformity (RUASs, 21%). The mean follow-up time was 43.4 months; and 93.9% of the patients had radiologic follow-up. No ureteral strictures were noted.
No significant difference was found in the overall success rates between the use of Applied NRUASs and RUASs. The presence of a pre-existing stent was significantly associated with successful sheath deployment. Each UAS design had its own unique limitations, seen with low frequency. Successful sheath use might relate to both the sheath itself and the patient/operative parameters.
输尿管通路鞘（UASs）用于辅助输尿管镜检查手术。已有使用困难的相关报道。制造商已对这些器械进行重新设计以改善这些问题，包括加强鞘壁。本研究比较了同一制造商生产的强化型（RUASs）和非强化型UASs（NRUASs），以确定RUASs是否能加快输尿管镜检查进程，以及强化结构在总体成功率方面的相关性。
我们前瞻性地随访了接受输尿管镜检查治疗尿路结石的患者，这些患者使用了两种UASs中的一种；即应用的NRUAS和应用的RUAS。评估了人口统计学、手术参数和结果。进行了统计分析。
共对68例男性和30例女性患者（47例使用NRUASs，51例使用RUASs）使用了98个UASs。两组在人口统计学参数、手术参数或鞘成功置入方面未发现显著差异。鞘置入的总体成功率为95%。预先存在的支架与成功置入显著相关（P = 0.004）。鞘特有的局限性包括扭结（NRUASs为10%）和鞘成角/变形（RUASs为21%）。平均随访时间为43.4个月；93.9%的患者进行了影像学随访。未发现输尿管狭窄。
应用NRUASs和RUASs的总体成功率未发现显著差异。预先存在的支架与鞘成功置入显著相关。每种UAS设计都有其独特的局限性，发生率较低。鞘的成功使用可能与鞘本身以及患者/手术参数有关。
