A Clinical Study On The Analysis Of The Ureteral Access Sheath Access Undesirability In The Primary Retrograde Intrarenal Surgery

Background and ObjectiveWith the development of endoscopic techniques,the retrograde intrarenal surgery(RIRS)has been used as an important treatment modality for upper urinary tract calculi.The use of ureteral access sheath(UAS)increased the efficacy of RIRS in the therapy for upper urinary tract calculi.But in the clinical application of UAS often encounter is not ideal and increase the difficulty of operation.According to foreign reports,the incidence rate is 9.8%~22% that UAS access failure in the first RIRS.Regarding to evaluating and identifying which patients characteristics impact the UAS placement,currently lacking reported literatures.The radiographic and clinical characteristics were collected and summarized from the medical record,analyzing and discussing the clinicoradiographic features for UAS placement before RIRS.The Study may assist in evaluating the risk of UAS access undesirability in the process of RIRS.MethodsA total of 109 patients with upper urinary tract calculus(94 with unilateral,15 with bilateral,124 renal units treated),who underwent RIRS in the Second Affiliated Hospital of Zhouzhou University from September 2015 to September 2016,were collected.According to whether successfully placing UAS or not during treatment,patients underwent RIRS for upper urinary tract calculi were divided into two groups(access ideal group,access not ideal group).Comparisons of general patients information and clinicoradiographic features were performed using the 2 sample students t and chi-square tests,as appropriate.All reported P values were 2 sided,with P<0.05 considered statistically significant.Statistical analyses were performed using the SPSS software version 22.0.ResultsOf the 109 patients treated,13(11.9%)patients for UAS access undesirability.10(76.9%)patients were indwelled Double-J ureteral stent because of UAS access failure and were placed Double-J stent at 2~4 weeks after the primary RIRS.3(23.1%)patients were performed successfully RIRS without UAS because of UAS access undesirability.This patients characteristics that were statistically significant differences between the ideal group and not ideal group include: prior Double-J ureteral stent(30.6% vs 0.0%,P<0.05),ureteral opacification on 30 min delay intravenous pyelogram(IVP)(8.1% vs 30.8%,P<0.05).Finally,this study also analyzed the data of using 12 Fr expander in the surgery.The comparison bewteen the two groups was statistically significant(5.4% vs 84.6%,P<0.001).Conclusions1.There was a higher success rate of UAS placement in patients with prior ipsilateral Double-J ureteral stent.2.A complete lack of ureteral opacification on 30 min delay intravenous pyelogram will increase the risk of UAS access undesirability.