title: Use of ureteral access sheaths in ureteroscopy.
abstract: The ureteral access sheath (UAS) facilitates the use of flexible ureteroscopy, enabling improved minimally invasive management of complex upper urinary tract diseases. The UAS, which comes in a variety of diameters and lengths, is passed in a retrograde fashion, aided by a hydrophilic coating and other features designed to confer smooth passage into the ureter with sufficient resistance to kinking and buckling. Use of a UAS has the advantage of enabling repeated passage of the ureteroscope while minimizing damage to the ureter, thus improving the flow of irrigation fluid and visualization within the urethra with reductions in operative times, which improves both the effectiveness of the surgery and reduces the costs. Placement of the UAS carries an increased risk of ureteral wall ischaemia and injury to the mucosal or muscular layers of the ureter, and a theoretically increased risk of ureteral strictures. A ureteral stent is typically placed after ureteroscopy with a UAS. Endourologists have found several additional practical uses of a UAS, such as the percutaneous treatment of patients with ureteral stones, and solutions to other endourological challenges.
authors.affiliation: Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Kaplan
authors.affiliation: Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
authors.affiliation: Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.affiliation: Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D004867:Equipment Design / Q000379:methods; D006801:Humans; D008297:Male; D015607:Stents / Q000706:statistics & numerical data*; D014513:Ureter / Q000601:surgery*; D020709:Ureteroscopes / Q000706:statistics & numerical data*; D018666:Ureteroscopy / Q000295:instrumentation*; D014570:Urologic Diseases / Q000601:surgery*