De Coninck Vincent, Somani Bhaskar, Sener Emre Tarik, Emiliani Esteban, Corrales Mariela, Juliebø-Jones Patrick, Pietropaolo Amelia, Mykoniatis Ioannis, Zeeshan Hameed Belthangady M, Esperto Francesco, Proietti Silvia, Traxer Olivier, Keller Etienne Xavier
Department of Urology, AZ Klina, 2930 Brasschaat, Belgium.
Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands.
J Clin Med. 2022 Aug 31;11(17):5128. doi: 10.3390/jcm11175128.
Ureteral access sheaths (UASs) are part of urologist's armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
输尿管通路鞘（UASs）是泌尿外科医生进行逆行性肾内手术（RIRS）时的器械装备之一。最近，随着三项具有变革性的技术发展：铥光纤激光（TFL）、更小尺寸的一次性使用数字柔性输尿管镜以及术中肾内压（IRP）测量设备，RIRS领域发生了巨大变化。我们旨在阐明UASs对IRP、并发症和结石清除率（SFRs）的影响，并结合这三项重大技术改进来探讨其适应证。两位作者使用Medline、Scopus和Web of Science数据库对文献进行了系统回顾，并根据PRISMA指南选择了相关研究。近期研究表明，在RIRS过程中使用UAS可通过增加冲洗液流出量来降低IRP和肾内温度。关于UAS对诊断性RIRS后的SFRs、术后疼痛、感染性并发症风险、输尿管狭窄风险以及尿路上皮癌膀胱复发风险的影响的数据尚无定论。预先置入支架至少一周可导致输尿管扩张，而术前使用α受体阻滞剂的影响尚不清楚。由于TFL、更小的一次性使用数字输尿管镜以及具有集成压力测量和抽吸技术的设备似乎可提高SFRs并减少与压力和温度相关的并发症，UAS的使用适应证在不久的将来可能会减少。
