title: Use of the ureteral access sheath during ureteroscopy in children.
abstract: OBJECTIVE
  The use of ureteral access sheaths during ureteroscopy is common but there are sparse data on the safety and outcomes of ureteral access sheath use in children. We compared the outcomes of ureteroscopy with vs without a ureteral access sheath in children.
  
  
  METHODS
  We retrospectively reviewed all ureteroscopy procedures for urolithiasis in patients younger than 21 years at our hospital from 1999 to 2009. The primary outcome was intraoperative complications. Secondary outcomes were postoperative hydronephrosis, emergency room visit/hospital readmission within 90 days, stone-free status and need for re-treatment. We analyzed associations of a ureteral access sheath with outcomes.
  
  
  RESULTS
  A total of 34 boys and 62 girls with a mean age of 13 years underwent ureteroscopy. A ureteral access sheath was used in 40 of the 96 patients (42%). The mean stone burden was 9.6 mm. Median followup was 11 months (range 0.2 to 110). Intraoperative complication occurred in 7 cases, including perforation/extravasation in 4, a submucosal wire in 2 and stent migration in 1. Intraoperative complications were more common when a sheath was used (15% vs 2%, adjusted OR 8.2, 95% CI 1.3-50.9, p = 0.02). Postoperative hydronephrosis was observed in 7 of 73 cases (10%) but it was not significantly more common when a sheath was used. No ureteral stricture was identified. Sheath use was not associated with postoperative telephone calls, emergency room visits or rehospitalization. Although the stone-free rate tended to be higher in cases without a sheath (78% vs 59%, p = 0.09), this association was not significant in a multivariate model (p = 0.6).
  
  
  CONCLUSIONS
  Although intraoperative complications occur more commonly during ureteroscopy with a ureteral access sheath, no increase in longer term adverse effects were observed. Future prospective studies of ureteral access sheath use in children with longer followup are warranted.
authors.affiliation: Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
authors.forename: Hsin-Hsiao
authors.initials: HH
authors.lastname: Wang
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.forename: Paul
authors.initials: P
authors.lastname: Kokorowski
authors.forename: Barley G
authors.initials: BG
authors.lastname: Cilento
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*; D052878:Urolithiasis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult