title: The effect of extralumenal safety wires on ureteral injury and insertion force of ureteral access sheaths: evaluation using an ex vivo porcine model.
abstract: OBJECTIVE
  To evaluate the effect that a safety wire (SW) had on insertion force and direct ureteral trauma using ureteral access sheaths (UAS) in an ex vivo porcine model.
  
  
  METHODS
  UASs were advance into 20 fresh ex vivo porcine kidney-ureters, either with or without SWs. The average and max force of insertion were recorded. Retrograde saline injection was used to identify the presence of lacerations.
  
  
  RESULTS
  For SW vs no SW, the mean insertion force (1.79 vs 0.67, P = .0003, respectively) and max insertion force (2.29 kg vs 1.00, P = .0007) was greater in the SW group. There were 9 lacerations, 6 of which were partial and 3 complete. Of the partial injuries, 2 were in the no SW group and 4 were in the SW group. Of the complete lacerations, 2 occurred in the no SW group and 1 in the SW group. However, there was no significant difference in the total number of lacerations (P = 1.00), the number of partial lacerations (P = .628), or the number of complete lacerations (P = 1.00) between the 2 groups.
  
  
  CONCLUSIONS
  The use of an SW significantly increases the force required to insert a UAS; however, it does not appear to affect the force or the degree of ureteral injury.
authors.affiliation: University of California, Department of Urology, Irvine, Orange, CA 92868, USA. joseph.graversen@gmail.com
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Graversen
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Valderrama
authors.forename: Ruslan
authors.initials: R
authors.lastname: Korets
authors.forename: Adam C
authors.initials: AC
authors.lastname: Mues
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.forename: Mantu
authors.initials: M
authors.lastname: Gupta
mesh_terms: D000818:Animals; D022125:Lacerations / Q000209:etiology*; D013314:Stress, Mechanical; D013552:Swine; D014513:Ureter / Q000293:injuries*; D020709:Ureteroscopes / Q000009:adverse effects*; D014546:Urinary Catheterization / Q000295:instrumentation*