Category: Clinical Stones: Ureteroscopy

MP32-8 - Results of ureteroscopy and stone treatment with the use of an access sheath: Prospective outcomes from a University teaching hospital

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

 Ureteral access sheath (UAS) is commonly used during flexible ureteroscopy and laser stone fragmentation (FURSL) to improve irrigation flow, lower intrarenal pressure and allow repeated in/out access to the kidney. Our aim was to evaluate the results of FURSL with the use of UAS in our University teaching hospital.

Methods :

Over a period of 6 years (March 2012-January 2017), 231 patients underwent ureteroscopy and stone treatment using UAS. Data on patient and stone demographics, operative and post-operative results were collected prospectively.

Results :  231 FURSL procedures were carried out using UAS with a male:female ratio of 129:102 and a mean age of 57 years (range: 2-86). Mean stone size was 18 mm (4-28) and 6.5% patients underwent bilateral FURSL.

 Size of access sheath used was 9.5/11.5 (37.6%), 10/12 (50.6%), 12/14 (5.6%), 14/16 (1%) and it was not specified in some cases. With a mean operating time of 58 min (range: 12-132), the stone free rate (SFR) was 92% with the majority of patients (91%) discharged the same day. While 29.5% had a pre-operative stent, 98.7% had a post-operative stent inserted ,which was removed 1-2 weeks post-procedure. There were no intra-operative complications and 12 patients (5%) developed post-operative complications. There were 9 cases of UTI or urosepsis needing antibiotics, 2 cases of re-admission for stent symptoms and 1 post-operative acute urinary retention.

Conclusions :  The use of an access sheath during elective flexible ureteroscopy is safe and enables excellent outcomes with a high stone free rate.

Amelia Pietropaolo

Urology senior fellow
University Hospital Southampton
Southampton, England, United Kingdom

Patrick Jones

University Hospital Southampton
Southampton, England, United Kingdom

Lily Whitehurst

Southampton, England, United Kingdom

Bhaskar K. Somani

Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom

Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.

He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.