Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

Olivier Traxer, Gunnar Wendt-Nordahl, Hiren Sodha, Jens Rassweiler, Shimon Meretyk, Ahmet Tefekli, Fernando Coz, Jean J de la Rosette, Olivier Traxer, Gunnar Wendt-Nordahl, Hiren Sodha, Jens Rassweiler, Shimon Meretyk, Ahmet Tefekli, Fernando Coz, Jean J de la Rosette

Abstract

Purpose: To describe the differences in the treatment and the outcomes of renal stones treated with flexible ureteroscopy (URS) either with or without the support of a ureteral access sheath (UAS).

Methods: The Clinical Research Office of the Endourological Society URS Global Study involved the collection of prospective data from consecutive patients treated with URS at centers around the world over a 1-year period. Baseline characteristics, stone location, treatment details, postoperative outcomes and complications were recorded. Inverse-probability-weighted regression adjustment (IPWRA) analyses were conducted on outcome from patients treated with or without the use of a UAS to determine the impact on stone-free rates (SFRs).

Results: Of 2239 patients treated with flexible URS, 1494 (67 %) patients were treated with the use of a UAS and 745 (33 %) without a UAS. The IPWRA analyses conducted on 1827 patients with complete data and based on treatment and outcome models showed that if URS procedures were performed without the use of an UAS, the average stone-free rate would be 0.504 compared with 0.753 with a UAS. This average treatment effect of 0.248 was not significant (P = 0.604). Using IPWRA analysis on only the treated population in the estimations revealed no significant difference between using and not using a UAS (31 %; ATET: 0.311; P = 0.523).

Conclusions: The study showed no difference in SFR when a UAS was used or not. Whereas UAS did not increase the risk of ureteral damage or bleeding, postoperative infectious complications were reduced.

Keywords: Complications; Renal stones; Ureteral access sheath treatment outcome; Ureteroscopy.

References

    1. L’Esperance JO, Ekeruo WO, Scales CD, Jr, Marguet CG, Springhart WP, Maloney ME, et al. Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology. 2005;66:252–255. doi: 10.1016/j.urology.2005.03.019.
    1. Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol. 2001;165:789–793. doi: 10.1016/S0022-5347(05)66527-5.
    1. Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol. 2007;21:119–123. doi: 10.1089/end.2007.9997.
    1. Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61:713–718. doi: 10.1016/S0090-4295(02)02440-8.
    1. Auge BK, Pietrow PK, Lallas CD, et al. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004;18:33–36. doi: 10.1089/089277904322836631.
    1. Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol. 2002;16:583–590. doi: 10.1089/089277902320913288.
    1. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189:580–584. doi: 10.1016/j.juro.2012.08.197.
    1. De la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, et al. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol. 2014;28:131–139. doi: 10.1089/end.2013.0436.
    1. Xie J, Liu C. Adjusted Kaplan–Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Stat Med. 2005;24:3089–4010. doi: 10.1002/sim.2174.
    1. Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M et al (2014) Guidelines on urolithiasis. European Association of Urology. . Accessed 9 Jan 2015
    1. Berquet G, Prunel P, Verhoest G, Mathieu R, Bensalah K. The use of ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World J Urol. 2014;32:229–232. doi: 10.1007/s00345-013-1181-5.
    1. Al-Qahtani SM, Letendre J, Thomas A, Natalin R, Saussez T, Traxer O. Which ureteral access sheath is compatible with your flexible ureteroscope? J Endourol. 2014;28:286–290. doi: 10.1089/end.2013.0375.
    1. Opondo D, Gravas S, Joyce A, Pearle M, Matsuda T, Sun Y, Assimos D, Denstedt J, de la Rosette J. Standardization of patient outcomes reporting in percutaneous nephrolithotomy. J Endourol. 2014;28(7):767–774. doi: 10.1089/end.2014.0057.
    1. Sugihara M. Survival analysis using inverse probability of treatment weighted methods based on the generalized propensity score. Pharm Stat. 2010;9:21–34. doi: 10.1002/pst.365.

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