title: Expanding applications of the access sheath to ureterolithotripsy of distal ureteral stones. A frustrating experience.
abstract: OBJECTIVE
  Distal ureteral stones are routinely managed with semirigid ureteroscopy without the need for ureteral dilatation, but some conditions, e.g. large stone burden or difficult catheterization of the ureteral meatus, are time-consuming and would require a tool to facilitate multiple insertions of the ureteroscope and to avoid ureteral injury. An access sheath is now available and it facilitates ureteroscopy of the upper ureter. To answer the question whether its application could be expanded to the distal ureter is the aim of our paper.
  
  
  METHODS
  12 distal ureteral stone patients, 8 with stone size >1 cm and 4 with a large prostate, underwent ballistic ureterolithotripsy with the aid of the Access Sheath. The results of the procedure were compared to a second group of 16 patients from our archives.
  
  
  RESULTS
  There was no significant difference in operating time and stone-free rate. Although no complications were related to the ureteroscopy, in 42% (5 patients) of the access group the procedure could be completed only after removing the sheath.
  
  
  CONCLUSIONS
  The Access Sheath does not improve the results of the semirigid ureteroscopy of difficult stones in the distal ureter.
authors.affiliation: Cattedra di Urologia, Azienda Universitaria Policlinico, Seconda Università degli Studi, Napoli, Italy. marcdesio@tin.it
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Andrea
authors.initials: A
authors.lastname: Oliva
authors.forename: Umberto
authors.initials: U
authors.lastname: Pane
authors.forename: Massimo
authors.initials: M
authors.lastname: D'Armiento
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000175:diagnosis / Q000628:therapy*; D018666:Ureteroscopy