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Journals / Bozok Tıp Dergisi / 2026 / Cilt: 15 Sayı: 3

Evaluation of The Effectiveness and Postoperative Urinary Tract Infection Development in RIRS Treatment Performed Without The Use of A Ureteral ‘Access Sheath’

ÜRETERAL ACCESS SHEATH KULLANILMADAN UYGULANAN RIRC TEDAVİSİNDE ETKİNLİK VE POSTOPERATİF ÜRİNER SİSTEM ENFEKSİYONU GELİŞİMİNİN DEĞERLENDİRİLMESİ

Haşmet Sarıcı(AFYON KOCATEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-1303-3931
Osman Gercek(AFYON KOCATEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-8710-7171
Berkay Eren(AFYON KOCATEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-1585-2578
Recep Uzun(AFYON KOCATEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-0841-8757
M. Ali Ulucak(AFYON KOCATEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0009-0004-3505-0769
Pages
240–248
Publication Date
2025-09-15
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Additionally, no ureteral injuries were observed, and the operation time was shorter without an access sheath.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: This study aims to evaluate the effects of stone location and size, the presence of a preoperative DJ stent, and preoperative positive urine culture on early postoperative infection in patients undergoing RIRS without the use of an access sheath due to kidney stones.
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Key Findings & Data:Additionally, we aim to compare the effects of stone location, size, and Hounsfield Unit (HU) value on stone-free rates.
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Conclusion & Impact:Additionally, no ureteral injuries were observed, and the operation time was shorter without an access sheath.
🔬Design:Araştırma Makalesi
📍Scope:2021 Verileri
⚙️Variables:Üreteral ‘Access Sheat’ · RIRC · Üriner Sistem Enfeksiyonu

Abstract

Aim: This study aims to evaluate the effects of stone location and size, the presence of a preoperative DJ stent, and preoperative positive urine culture on early postoperative infection in patients undergoing RIRS without the use of an access sheath due to kidney stones. Additionally, we aim to compare the effects of stone location, size, and Hounsfield Unit (HU) value on stone-free rates. Materials and Methods: This retrospective study was conducted on 326 patients who underwent RIRS + Laser Lithotripsy without the use of an access sheath, followed by DJ-stent placement, between January 2021 and March 2024. Postoperative infection, the need for re-RIRS, and stone-free status at 4 weeks postoperatively were analyzed. Results: When comparing patients with and without postoperative infections, there was no statistically significant difference between the groups in terms of age, gender, stone volume, stone location or operation time (p=0.968, p=0.346, p=0.318, p=0.151, p=0.621, respectively). Preoperative DJ stent placement was significantly higher in the infection group (35.2% vs. non-infection group, p=0.002). Residual stones were also significantly more common in the infection group (p<0.001), with a higher incidence of lower pole and multiple stones (p=0.016). Conclusion: Routine use of a ureteral access sheath is not always necessary for RIRS in kidney stone treatment. Success and stone-free rates are related to stone size, location, and HU value. Additionally, no ureteral injuries were observed, and the operation time was shorter without an access sheath.

Özet

Amaç: Biz bu çalışmamızda böbrek taşları nedeni ile ‘Access Sheath’ kullanılmadan Retrograd İntrarenal Cerrahi (RIRC) uyguladığımız hastalarda, taşın böbrekteki yerleşim yeri ile taşın boyutu, preoperatif Double J Stent (DJS) varlığı ve preoperatif pozitif idrar kültürü varlığının postoperatif erken dönem enfeksiyon gelişimine etkisini ve taşın böbrekteki yerleşim yeri ile taşın boyutu ve Hounsfield Unit (HU) değerinin taşsızlık oranlarına etkisini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışma Ocak 2021 – Mart 2024 tarihleri arasında böbrek taşı nedeni ile ‘Access Sheath’ kullanılmadan RIRC + Laser Litotripsi uyguladığımız ve DJ Stent yerleştirilen 326 hasta üzerinde yapılmıştır. Hastaların Re-Do Retrograd Intrarenal Cerrahi (Re-RIRC) gereksinimi, postoperatif erken dönem enfeksiyon gelişimi ve postoperatif 4. Haftada renal taşsızlık durumları incelenmiştir. Bulgular: Bu çalışmada postoperatif enfeksiyon gelişen ve gelişmeyen hastalar iki farklı grup olarak incelendiğinde; gruplar arasında, yaş, cinsiyet, taş hacmi, taş lokalizasyonu ve operasyon süresi açısından istatistiksel anlamlı fark saptanmadı (sırasıyla; p=0,968, p=0,346, p=0,318, p=0,151, 0,621). Postoperatif enfeksiyon gelişen grupta 19 (%35,2) hastada preoperatif DJS takıldığı izlendi ve bu oran enfeksiyon gelişmeyen gruba göre anlamlı olarak yüksekti (p=0,002). Ayrıca postoperatif enfeksiyon gelişen grupta, gelişmeyen gruba göre anlamlı derecede yüksek rezidü taş varlığı saptandı (p<0,001). Rezidü taş saptanan grupta alt pol ve multipl taş varlığının diğer gruba göre anlamlı olarak yüksek olduğu görüldü (p=0,016). Sonuç: Böbrek taşlarının RIRC ile tedavisinde rutin olarak Üreteral ‘Access Sheath’ kullanımı her zaman gerekli değildir. Üreteral ‘Access Sheath’ kullanılmadan uygulanan cerrahilerin başarısı, taşsızlık oranları, taşın HU değeri ve taş hacmi ile ilişkilidir. Ayrıca ‘Access Sheath’ kullanılarak yapılan cerrahilerde görülen üreteral yaralanmalar uyguladığımız hiçbir cerrahide görülmemiştir ve operasyon süresi daha kısadır.

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Cite This Article

Sarıcı, H., Gercek, O., Eren, B., Uzun, R., Ulucak, M. A. (2025). Evaluation of The Effectiveness and Postoperative Urinary Tract Infection Development in RIRS Treatment Performed Without The Use of A Ureteral ‘Access Sheath’. Bozok Tıp Dergisi, Cilt: 15 Sayı: 3, 240–248. https://ajindex.com/articles/1377285

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References (26)

  1. Romero V., Akpinar H., Assimos D.G. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev. Urol. 2010;12:e86–e96.
  2. Cauni V., Mihai B., Tănase F., Perşu C., Ciofu I. Application of laser technology in urinary stone treatment. 2022;67:85–9.
  3. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, Liatsikos E, et al. Trends of ‘‘urolithiasis: interventions, simulation, and laser technology’’ over the last 16 years (2000---2015) as published in the literature (PubMed): a systematic review from European section of Uro-technology (ESUT). World J Urol. 2017;35:1651-8.
  4. Lin C-B, Chuang S-H, Shih H-J, Pan Y. Utilization of Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. Medicina. 2024; 60(7):1084.
  5. Takayasu, H.; Aso, Y. Recent Development for Pyeloureteroscopy: Guide Tube Method for Its Introduction into the Ureter. J Urol. 1974;112(2):176-8.
  6. Kourambas J, Byrne RR, Preminger GM. Does a ureteral Access sheath facilitate ureteroscopy? J Urol. 2001;165:789-93.
  7. L’esperance JO, Ekeruo WO, Scales CD, Marguet CG, PatrickSpringhart W, Maloney ME, et al. Effect of ureteral access sheathon stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology. 2005;66:252-5.
  8. Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral Access Sheath Provides Protection against Elevated Renal Pressures during Routine Flexible Ureteroscopic StoneManipulation. J Endourol. 2004;18:33-6. 9. Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61:713-8.
  9. Türk C, Petrík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al.EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82
  10. Assimos D, Krambeck A, Miller NL, Monga M, Hassan Murad M,Nelson CP, et al. Surgical Management of Stones: American Urological. Association/Endourological Society Guideline, PART I. J Urol. 2016;196:1153-60.
  11. Huang J, Zhao Z, AlSmadi JK, Liang X, Zhong F, Zeng T, et al., Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis. PLoS One. 2018;28;13;2:e0193600
  12. Stern JM, Yiee J, Park S. Safety And Efficacy of Ureteral AccessSheaths. J Endourol. 2007;21(2):119-23.
  13. Breda A, Territo A, López-Martínez JM. Benefits and risks of ureteral access sheaths for retrograde renal access. Curr Opin Urol. 2016;26(1):70-5.
  14. Özsoy M, Kyriazis I, Vrettos T, Kotsiris D, Ntasiotis P, Seitz C,et al. Histological changes caused by the prolonged placement of ureteral access sheaths: an experimental study in porcine model. Urolithiasis. 2018;46(4):397-404.
  15. Lildal SK, Andreassen KH, Jung H, Pedersen MR, Osther PJS. Evaluation of ureteral lesions in ureterorenoscopy: impact of access sheath use. Scand J Urol. 2018;52(2):157-61.
  16. Cybulski P, John D’A, Honey R, Pace K. Fluid Absorption during Ureterorenoscopy. J Endourol. 2004;18(8):739-42.
  17. Traxer O, Wendt-Nordahl G, Sodha H, Rassweiler J, Meretyk S,Tefekli A, et al. Differences in renal stone treatment and out-comes for patients treated either with or without the supportof a ureteral access sheath: The Clinical Research Office of theEndourological Society Ureteroscopy Global Study. World J Urol.2015;33(12):2137- 44.
  18. Cristallo C, Santillán D, Tobia I, Tirapegui FI, Daels FP, González MS. Flexible ureteroscopy without ureteral access sheath. Actas Urol Esp (Engl Ed). 2022;46(6):354-60.
  19. Berquet G, Prunel P, Verhoest G, Mathieu R, Bensalah K. Theuse of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World J Urol. 2014;32(1):229-32.
  20. Traxer O, Dubosq F, Jamali K, Gattegno B, Thibault P. Newgeneration flexible ureterorenoscopes are more durable than previous ones. Urology. 2006;68(2):276-9.
  21. Pietrow PK, Auge BK, Delvecchio FC, Silverstein AD, Weizer AZ, Albala DM, et al. Techniques to maximize flexible ureteroscope longevity. Urology. 2002;60(5):784-8.
  22. Multescu R, Geavlete B, Georgescu D, Geavlete P. Improved Durability of Flex-Xc Digital Flexible Ureteroscope: How Long Can You Expect It to Last? Urology. 2014;84(1):32-5.
  23. Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser Doppler Flowmetric Determination of Ureteral Blood Flow after Ureteral Access Sheath Placement. J Endourol.2002;16(8):583-90.
  24. Torricelli FC, De S, Hinck B, Noble M, Monga M. Flexibleureteroscopy with a ureteral access sheath: when to stent?Urology. 2014;83(2):278-81.
  25. Jiang P, Xie L, Arada R, Patel RM, Landman J, Clayman RV. Qualitative Review of Clinical Guidelines for Medical and Surgical Management of Urolithiasis: Consensus and Controversy 2020. J Urol. 2021;205(4):999-1008.
  26. Jiang P, Xie L, Arada R, Patel RM, Landman J, Clayman RV. Qualitative Review of Clinical Guidelines for Medical and Surgical Management of Urolithiasis: Consensus and Controversy 2020. J Urol. 2021;205(4):999-1008.