{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T21:28:45Z","timestamp":1788643725466,"version":"build-2803163510"},"reference-count":29,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"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":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Objective:<\/jats:title>\n                    <jats:p>Ureteral injury is a clinical concern during placement of a ureteral access sheath (UAS). Herein, we identify factors contributing to the clinically successful passage of 16F UASs using a previously established safe force threshold of \u22646 Newtons (N).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>UAS force sensor measurements were recorded during ureteroscopic procedures in 250 renal units (238 patients). If 6 N was reached during insertion of the UAS, the surgeon was advised to downsize from a 16F UAS to a smaller sheath. In each case, a post-ureteroscopic lesion scale (PULS) grade was recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A 16F UAS was safely deployed in 145 (58%) renal units with a mean maximum force of 5.5 N. Two renal units sustained a high-grade ureteral injury (PULS 3), both of which had forces of deployment \u22658 N. Independent favorable factors for passage of a 16F UAS included: presence of a preoperative indwelling ureteral stent (76.5% passage) (OR: 3.049,\n                      <jats:italic toggle=\"yes\">p =<\/jats:italic>\n                      0.002) and a course of oral antibiotics within 6 weeks of the procedure with or without an associated urinary tract infection (68.4% and 59.6% passage) (OR: 3.133,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002 and 2.046,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.034). Preoperative tamsulosin was not of benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Adherence to a force threshold of \u22646 N during UAS passage resulted in safe passage of a 16F UAS in 58% of 250 renal units; when adhering to the recommended \u22646 N force threshold, there were no PULS 3 injuries. A preexisting indwelling ureteral stent and administration of antibiotics within 6 weeks of the procedure independently favored safe passage of a 16F UAS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08927790251400350","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:01:13Z","timestamp":1764316873000},"page":"296-302","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Ureteral Access Sheath Deployment: Understanding the Force Tolerance of the Human Ureter and the Development of Ureteral Injury During Endoscopic Surgery"],"prefix":"10.1177","volume":"40","author":[{"given":"Sohrab N.","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"McCormac","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedamirvala","family":"Saadat","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Amiryaghoub M.","family":"Lavasani","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei D.","family":"Cumpanas","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariah C.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh-Chau","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Afyouni","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Altamirano-Villarroel","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary E.","family":"Tano","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Osann","sequence":"additional","affiliation":[{"name":"Department of Medicine and Program in Public Health, University of California, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Klopfer","sequence":"additional","affiliation":[{"name":"Henry Samueli School of Engineering, University of California, Irvine, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengbo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Landman","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph V.","family":"Clayman","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, 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Physiology and pharmacology of the renal pelvis and ureter - ClinicalKey. Available from: https:\/\/www.clinicalkey.com\/#!\/content\/book\/3-s2.0-B9780323546423000859 [Last accessed: February11 2025]."},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2024.0315"}],"container-title":["Journal of Endourology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08927790251400350","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08927790251400350","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08927790251400350","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T07:11:20Z","timestamp":1787123480000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08927790251400350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,1]]}},"alternative-id":["10.1177\/08927790251400350"],"URL":"https:\/\/doi.org\/10.1177\/08927790251400350","relation":{},"ISSN":["0892-7790","1557-900X"],"issn-type":[{"value":"0892-7790","type":"print"},{"value":"1557-900X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}