{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:29:42Z","timestamp":1778858982209,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but their use is not without potential risk. We investigated patterns of UAS use and associated outcomes across practices in Michigan within a quality improvement collaborative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative maintains a web-based, prospective clinical registry of patients undergoing URS for urinary stone disease (USD). We analyzed all patients undergoing primary URS for renal and ureteral stones from June 2016 to July 2018 in the ROCKS registry. We determined rates of UAS usage across practices and associated outcomes, including 30-day emergency department (ED) visits and hospitalization, as well as stone-free rates. Using multivariate logistical regression, we determined the predictors of UAS use as well as outcomes, including stone-free rates, ED visits, and hospitalizations, associated with UAS use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 5316 URS procedures identified, UASs were used in 1969 (37.7%) cases. Stones were significantly larger and more likely to be located in the kidney in cases with UAS use. UAS use during URS varied greatly across practices (1.9%\u201396%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). After adjusting for clinical and surgical risk factors, UAS use significantly increased the odds of postoperative ED visits (odds ratio [OR]\u2009=\u20091.50, 95% confidence interval [CI] 1.17\u20131.93,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and hospitalization (OR\u2009=\u20091.77, 95% CI 1.22\u20132.56,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) as well as decreased the odds of being stone free (OR\u2009=\u20090.75, 95% CI 0.57\u20130.99,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In the current study, UAS use during URS for USD was not associated with an increased likelihood of being stone free; moreover, it increased the odds of a postoperative ED visit and or hospitalization. Our findings demonstrate that UAS use is not without risk and should be employed judiciously.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/end.2020.1077","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:46:56Z","timestamp":1617842816000},"page":"1340-1347","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":33,"title":["Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4384-4994","authenticated-orcid":false,"given":"Kristen","family":"Meier","sequence":"first","affiliation":[{"name":"Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spencer","family":"Hiller","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casey","family":"Dauw","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaya","family":"Telang","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khurshid R.","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Mohammad A.","family":"Jafri","sequence":"additional","affiliation":[{"name":"Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics (NHCS). National Health and Nutrition Examination Survey Questionnaire. 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