Department of Urology, University of California, Irvine.
Department of Surgery, Section of Urology, University of Calgary, Alberta, Canada.
J Urol. 2021 Aug;206(2):364-372. doi: 10.1097/JU.0000000000001719. Epub 2021 Mar 29.
Ureteral injury is a frequent complication of ureteral access sheath deployment. We sought to define the safe threshold of force for the passage of a ureteral access sheath using a novel ureteral access sheath force sensor.
Ureteral access sheath-force sensor measurements were recorded in 210 renal units. A 16Fr ureteral access sheath was deployed initially based on a prior porcine study. If 6 N was reached, the surgeon was advised to downsize the 16Fr ureteral access sheath. In each case, a post-ureteroscopic lesion scale was recorded. Regression models were used to estimate the impact of adjusted variables on post-ureteroscopic lesion scale grade, 16Fr ureteral access sheath deployment, and peak force.
A 16Fr ureteral access sheath was deployed in 127 (61%) renal units with a mean peak force of 5.7 N. Two high-grade ureteral injuries occurred; in both cases >6 N of force was recorded. Post-ureteroscopic lesion scale grade correlated directly with peak insertion force (p <0.01). Bacteriuria within 60 days of the procedure (OR 2.009, p=0.034), combination of preoperative stent plus oral tamsulosin (OR 2.998, p=0.045), and prior ipsilateral stone surgery (OR 2.13, p=0.01) were independent predictors of successful 16Fr ureteral access sheath deployment. Among patients with neither prior ipsilateral stone surgery nor preoperative stent, preoperative tamsulosin facilitated passage of a 16Fr ureteral access sheath (OR 2.750, p=0.034).
Ureteral access sheath associated ureteral injury can be averted by limiting the insertion force to ≤6 N. Prior stone surgery, preoperative indwelling ureteral stent plus oral tamsulosin, and recently treated bacteriuria favored passage of a 16Fr ureteral access sheath. In the naïve, unstented patient, preoperative tamsulosin favored deployment of a 16Fr ureteral access sheath.
输尿管损伤是输尿管鞘管置入的常见并发症。我们试图通过一种新的输尿管鞘管力传感器来确定输尿管鞘管通过的安全力阈值。
在 210 个肾脏单位中记录了输尿管鞘管力传感器的测量值。根据先前的猪研究，最初部署 16Fr 输尿管鞘管。如果达到 6N，外科医生将被建议减小 16Fr 输尿管鞘管的尺寸。在每种情况下，都会记录输尿管镜检查后的损伤量表。回归模型用于估计调整变量对输尿管镜检查后损伤量表等级、16Fr 输尿管鞘管放置和峰值力的影响。
在 127 个（61%）肾脏单位中成功部署了 16Fr 输尿管鞘管，平均峰值力为 5.7N。发生了 2 例高等级输尿管损伤；在这两种情况下，都记录到超过 6N 的力。输尿管镜检查后的损伤量表等级与插入力峰值直接相关（p<0.01）。术后 60 天内发生菌尿症（OR 2.009，p=0.034）、术前支架加口服坦索罗辛（OR 2.998，p=0.045）和同侧结石手术史（OR 2.13，p=0.01）是成功放置 16Fr 输尿管鞘管的独立预测因素。在既没有同侧结石手术史也没有术前支架的患者中，术前坦索罗辛有助于通过 16Fr 输尿管鞘管（OR 2.750，p=0.034）。
通过将插入力限制在≤6N，可以避免输尿管鞘管相关的输尿管损伤。同侧结石手术史、术前留置输尿管支架加口服坦索罗辛以及近期治疗的菌尿症有利于 16Fr 输尿管鞘管的通过。在未接受支架治疗的患者中，术前坦索罗辛有利于放置 16Fr 输尿管鞘管。
