title: Single-center clinical comparison of two reinforced ureteral access sheaths for retrograde ureteroscopic treatment of urinary lithiasis.
abstract: BACKGROUND
  Ureteral access sheaths (UAS) are used to facilitate ureteroscopic procedures. Difficulties in use, including sheath distortion, buckling, and difficulty in placement, have been reported. However, few clinical comparisons have been performed. We present the first large-scale comparison of the Applied ForteXE(®) and ACMI-Gyrus Uropass(®) UAS.
  
  
  METHODS
  We retrospectively compared patients who underwent ureteroscopy for urolithiasis with one of two types of UAS: Applied Forte XE(®) or ACMI-Gyrus Uropass(®). Demographics, operative parameters, and outcomes were assessed. Statistical analysis was performed.
  
  
  RESULTS
  In 125 (64.4%) male and 69 (35.6%) female patients, 194 UAS were used. One hundred and thirteen (58.2%) Applied Forte XE(®) and 81 (41.8%) ACMI-Gyrus Uropass(®) were utilized. Success rates for sheath deployment were as follows: overall = 186/194 (95.8%); Applied Forte XE(®) = 107/113 (94.7%); and ACMI-Gyrus Uropass(®) = 79/81 (97.5%) (P = 0.472). Of the 194 patients 131 (67.5%) had a pre-existing stent. Sheath deployment failures occurred in 7 men and 1 woman, of which 4/8 (50%) had no pre-existing stent. Limitations of deployed sheaths occurred at low frequency in both Applied Forte XE 17/107 (15.9%) and ACMI-Gyrus 6/79 (7.6%), with no significant difference observed (P = 0.120). Limitations in use was high in men (P = 0.019). At a mean follow-up of 41 months, no ureteral strictures were noted.
  
  
  CONCLUSIONS
  No significant differences were seen in overall success rates for both sheaths. Both sheaths had high deployment success rates and a similar low frequency of sheath-related limitations. We noted increased limitations in the use of deployed sheaths in men. Successful sheath use may depend on both the sheath itself and patient/operative parameters.
authors.affiliation: Department of Urology, University of Miami/Miller School of Medicine, PO Box 016960 (M814), Miami, FL 33101, USA.
authors.forename: Rajinikanth
authors.initials: R
authors.lastname: Ayyathurai
authors.forename: Prashanth
authors.initials: P
authors.lastname: Kanagarajah
authors.forename: John
authors.initials: J
authors.lastname: Shields
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Young
authors.forename: Alina
authors.initials: A
authors.lastname: Alvarez
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D052878:Urolithiasis / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult