title: Novel everting urologic access sheath: decreased axial forces during insertion.
abstract: BACKGROUND
  Advancement of urologic instruments through the genitourinary tract is associated with significant axial forces that likely contribute to patient discomfort, even after injection of a local anesthetic, and may lead to mucosal trauma, postprocedural dysuria and hematuria, and increased susceptibility to infection and strictures. Placing an everting urethral sheath prior to instrumentation may decrease these problems.
  
  
  METHODS
  Two 7-cm-long, 5-mm diameter urethral luminal models were created, one with and one without an artificial stricture. We measured the forces generated during advancement of a novel everting access sheath (Cystoglide; Percutaneous Systems, Mountain View, CA) through the models in comparison with a representative cystoscope and a urologic dilator simulating a traditional access sheath.
  
  
  RESULTS
  The mean force generated during advancement of the everting sheath was significantly less than that of both the representative cystoscope (P<0.01) and the traditional access sheath (P<0.01). This held true for the urethral models both with and without an artificial stricture (P<0.01) and with and without lubrication (P<0.01).
  
  
  CONCLUSIONS
  This novel introduction sheath markedly decreased the axial forces applied to an artificial urethral luminal wall. It is possible that the clinical use of this technology will decrease the discomfort and potential complications associated with lower urinary-tract endoscopy.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California 94143-1611, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Rubenstein
authors.forename: Maurice
authors.initials: M
authors.lastname: Garcia
authors.forename: Affonso H L A
authors.initials: AH
authors.lastname: Camargo
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Joel
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Stoller
mesh_terms: D019723:Endoscopes; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008953:Models, Anatomic; D014521:Urethra / Q000293:injuries*; D014524:Urethral Obstruction / Q000628:therapy