{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:52:38Z","timestamp":1779209558500,"version":"3.51.4"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T00:00:00Z","timestamp":1676160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Materials and methods: Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10\/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients\u2019 characteristics and operative data and the rate of postoperative infectious complications. Results: Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p &gt; 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08\u2013197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07\u20131.42, sepsis-OR = 1.47; 95% CI = 1.09\u20131.99, and septic shock-OR = 1.61; 95% CI = 1.08\u20132.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02\u20134.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12\u201321.25) did emerge as further associated risk factors. Conclusions: The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients\u2019 baseline characteristics remain the main predictors of infectious sequelae in a clinical setting.<\/jats:p>","DOI":"10.3390\/jcm12041457","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T01:48:56Z","timestamp":1676252936000},"page":"1457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center"],"prefix":"10.3390","volume":"12","author":[{"given":"Luca","family":"Villa","sequence":"first","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Dioni","sequence":"additional","affiliation":[{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Candela","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"},{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Ventimiglia","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"De Angelis","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Corsini","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Robesti","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita","family":"Fantin","sequence":"additional","affiliation":[{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"D\u2019Arma","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Proietti","sequence":"additional","affiliation":[{"name":"Unit of Urology, San Raffaele Turro, IRCCS Ospedale San Raffaele, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Giusti","sequence":"additional","affiliation":[{"name":"Unit of Urology, San Raffaele Turro, IRCCS Ospedale San Raffaele, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3309-9807","authenticated-orcid":false,"given":"Ioannis","family":"Kartalas Goumas","sequence":"additional","affiliation":[{"name":"Department of Urology, Istituto Clinico Beato Matteo, 27029 Vigevano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Briganti","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"},{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Montorsi","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"},{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Salonia","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina, 20132 Milan, Italy"},{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1007\/s00345-019-03012-1","article-title":"Complications of ureteroscopy: A complete overview","volume":"38","author":"Keller","year":"2020","journal-title":"World J. 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