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Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis

BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of...

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Autores principales: Sari, Sercan, Cakici, Mehmet Caglar, Aykac, Aykut, Baran, Ozer, Selmi, Volkan, Karakoyunlu, Ahmet Nihat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: King Faisal Specialist Hospital and Research Centre 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532051/
https://www.ncbi.nlm.nih.gov/pubmed/33007166
http://dx.doi.org/10.5144/0256-4947.2020.382
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author Sari, Sercan
Cakici, Mehmet Caglar
Aykac, Aykut
Baran, Ozer
Selmi, Volkan
Karakoyunlu, Ahmet Nihat
author_facet Sari, Sercan
Cakici, Mehmet Caglar
Aykac, Aykut
Baran, Ozer
Selmi, Volkan
Karakoyunlu, Ahmet Nihat
author_sort Sari, Sercan
collection PubMed
description BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.
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spelling pubmed-75320512020-10-13 Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis Sari, Sercan Cakici, Mehmet Caglar Aykac, Aykut Baran, Ozer Selmi, Volkan Karakoyunlu, Ahmet Nihat Ann Saudi Med Original Article BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None. King Faisal Specialist Hospital and Research Centre 2020-09 2020-10-01 /pmc/articles/PMC7532051/ /pubmed/33007166 http://dx.doi.org/10.5144/0256-4947.2020.382 Text en Copyright © 2020, Annals of Saudi Medicine, Saudi Arabia This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). The details of which can be accessed at http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Original Article
Sari, Sercan
Cakici, Mehmet Caglar
Aykac, Aykut
Baran, Ozer
Selmi, Volkan
Karakoyunlu, Ahmet Nihat
Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title_full Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title_fullStr Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title_full_unstemmed Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title_short Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
title_sort outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532051/
https://www.ncbi.nlm.nih.gov/pubmed/33007166
http://dx.doi.org/10.5144/0256-4947.2020.382
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