{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:44:02Z","timestamp":1768898642608,"version":"3.49.0"},"reference-count":19,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T00:00:00Z","timestamp":1685923200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Objective: We aimed to evaluate and compare the functional characteristics, safety profile and effectiveness of two commonly used ureteral access sheaths (UAS) during flexible ureteroscopy. Methods: After institutional review board approval, patients with proximal ureteral or kidney stones requiring flexible ureteroscopy and UAS were prospectively randomized to group I or group II according to the type of access sheath used. Primary outcome was incidence of intraoperative complications. Results: Eighty-eight patients were enrolled in the study, 44 patients in each group. Sheath size 12\/14 FR was used in both cohorts. Median (IQR) stone size was 10 mm (7-13.5) and 10.5 mm (7.37-14) in group I and II respectively (p = 0.915). Nineteen and twenty patients, in group I and II respectively, were pre-stented. Subjective resistance with insertion of the UAS was observed in 9 and 11 patients in group I and II respectively (p = 0.61) while failed insertion was encountered in one patient in group I. Traxer grade 1 ureteral injury was noted in 5 and 6 patients in group I and II respectively while grade 3 injury was seen in 1 patient for both cohorts (p = 0.338). There was less resistance for UAS placement in pre-stented patients (p = 0.0202) but without significant difference in ureteric injury incidence (p = 0.175). Emergency department visits were encountered in 7 (group I) and 5 patients (group II) (p = 0.534). Conclusions: The studied UASs were comparable regarding safety and efficacy in the current study. Pre-stented and dilated ureters had less resistance to insertion although this was not reflected on incidence of ureteric injury.<\/jats:p>","DOI":"10.4081\/aiua.2023.11149","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T11:39:04Z","timestamp":1685965144000},"source":"Crossref","is-referenced-by-count":4,"title":["Comparison of commonly utilized ureteral access sheaths: A prospective randomized trial"],"prefix":"10.4081","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3341-3648","authenticated-orcid":false,"given":"Mohamed","family":"Elsaqa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-9558","authenticated-orcid":false,"given":"Zain","family":"Hyder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Thai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Dowd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amr","family":"El Mekresh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristofer","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belur","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-7413","authenticated-orcid":false,"given":"Patrick","family":"Lowry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-2953","authenticated-orcid":false,"given":"Marawan M.","family":"El Tayeb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2023,6,5]]},"reference":[{"key":"78782","doi-asserted-by":"crossref","unstructured":"Doizi S, Traxer O. Flexible ureteroscopy: technique, tips and tricks. Urolithiasis. 2018; 46:47-58.","DOI":"10.1007\/s00240-017-1030-x"},{"key":"78783","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Monsalve Herrero M, Doizi S, Keller EX, et al. Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis. Asian J Urol. 2018; 5:264-273.","DOI":"10.1016\/j.ajur.2018.06.005"},{"key":"78784","doi-asserted-by":"crossref","unstructured":"Inoue T, Okada S, Hamamoto S, Fujisawa M. Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol. 2021; 62:121-135.","DOI":"10.4111\/icu.20200526"},{"key":"78785","doi-asserted-by":"crossref","unstructured":"De Coninck V, Keller EX, Rodr\u00edguez-Monsalve M, et al. Systematic review of ureteral access sheaths: facts and myths. BJU Int. 2018; 122:959-969.","DOI":"10.1111\/bju.14389"},{"key":"78786","doi-asserted-by":"crossref","unstructured":"Auge BK, Pietrow PK, Lallas CD, et al. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004; 18:33-6.","DOI":"10.1089\/089277904322836631"},{"key":"78787","doi-asserted-by":"crossref","unstructured":"Wong VK, Aminoltejari K, Almutairi K, et al. Controversies associated with ureteral access sheath placement during ureteroscopy. Investig Clin Urol. 2020; 61:455-463.","DOI":"10.4111\/icu.20200278"},{"key":"78788","doi-asserted-by":"crossref","unstructured":"Meier K, Hiller S, Dauw C, et al. Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes. J Endourol. 2021; 35:1340-1347.","DOI":"10.1089\/end.2020.1077"},{"key":"78789","doi-asserted-by":"crossref","unstructured":"Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol. 2007; 21:119-23.","DOI":"10.1089\/end.2007.9997"},{"key":"78790","doi-asserted-by":"crossref","unstructured":"Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013; 189:580-4.","DOI":"10.1016\/j.juro.2012.08.197"},{"key":"78791","doi-asserted-by":"crossref","unstructured":"Yoshida T, Inoue T, Abe T, Matsuda T. Evaluation of Intrapelvic Pressure When Using Small-Sized Ureteral Access Sheaths of \u2264 10\/12F in an Ex Vivo Porcine Kidney Model. J Endourol. 2018; 32:1142-1147.","DOI":"10.1089\/end.2018.0501"},{"key":"78792","doi-asserted-by":"crossref","unstructured":"Sener TE, Cloutier J, Villa L, et al. Can We Provide Low Intrarenal Pressures with Good Irrigation Flow by Decreasing the Size of Ureteral Access Sheaths? J Endourol. 2016; 30:49-55.","DOI":"10.1089\/end.2015.0387"},{"key":"78793","doi-asserted-by":"crossref","unstructured":"De S, Sarkissian C, Torricelli FC, et al. New ureteral access sheaths: a double standard. Urology. 2015; 85:757-63.","DOI":"10.1016\/j.urology.2014.07.009"},{"key":"78794","doi-asserted-by":"crossref","unstructured":"Patel N, Monga M. Ureteral access sheaths: a comprehensive comparison of physical and mechanical properties. Int Braz J Urol. 2018; 44:524-535.","DOI":"10.1590\/s1677-5538.ibju.2017.0575"},{"key":"78795","doi-asserted-by":"crossref","unstructured":"Loftus CJ, Ganesan V, Traxer O, et al. Ureteral Wall Injury with Ureteral Access Sheaths: A Randomized Prospective Trial. J Endourol. 2020; 34:932-936.","DOI":"10.1089\/end.2018.0603"},{"key":"78796","doi-asserted-by":"crossref","unstructured":"Yuk HD, Park J, Cho SY, et al. The effect of preoperative ureteral stenting in retrograde Intrarenal surgery: a multicenter, propensity score-matched study. 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