title: Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi.
abstract: OBJECTIVE
  To evaluate the effect of ureteral access sheaths (UASs) on stone-free rates (SFRs) during ureteroscopic treatment of renal calculi. Several advantages of UASs during flexible ureteroscopy have been documented. However, no study has evaluated their impact on SFRs.
  
  
  METHODS
  We retrospectively reviewed all ureteroscopic cases for the management of renal stones performed at our Stone Center. Data were stratified according to the use or lack of use of the UAS. The groups were stratified by stone location within the kidney. Stone-free status was determined at 2 months postoperatively by either intravenous urography with tomograms or noncontrast renal computed tomography in patients with contrast allergies.
  
  
  RESULTS
  A total of 256 ureteroscopic procedures for the removal of renal calculi were performed between 1997 and 2003 (173 with UAS and 83 without). The groups were similar in age, sex, and stone burden. Stents were placed in nearly 80% of patients. The lower renal pole represented the most common presenting location. Stone displacement with a ureteroscopic basket for efficient fragmentation was necessary in 34%. The overall SFR in the UAS group and non-UAS group was 79% and 67%, respectively (P = 0.042). The SFRs were improved for calculi in all portions of the kidney.
  
  
  CONCLUSIONS
  In addition to facilitating ureteroscopic access, reducing costs, and lowering intrarenal pressures, the results of the current study suggest that UASs improve SFRs during the management of renal calculi. It is now our current practice to use the UAS routinely during ureteroscopic treatment of renal and upper ureteral calculi.
authors.affiliation: Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: L'esperance
authors.forename: Wesley O
authors.initials: WO
authors.lastname: Ekeruo
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.forename: Charles G
authors.initials: CG
authors.lastname: Marguet
authors.forename: W Patrick
authors.initials: WP
authors.lastname: Springhart
authors.forename: Michaella E
authors.initials: ME
authors.lastname: Maloney
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D020709:Ureteroscopes