Comparison between Flexible Ureteroscopy by Using Uretral Access Sheath and Flexible Ureterosopy without Using Ureteral Access Sheath in Cases of Upper Ureteric and Pelvic Stones

Abstract Background Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question. Aim of the Work to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. Patients and Methods This randomized controlled clinical trial was conducted in Urology Department, Ain Shams, University Hospitals and included 50 upper ureteric stone disease patients. They were divided into 2 comparative groups (each group 25 patients) by closed envelop method. One of these groups underwent FURS with ureteral access sheath and the second group underwent FURS without ureteral access sheath. Results there was no significant difference between the 2 groups regarding demographic or clinical data. Moreover, no significant difference was detected between the 2 groups regarding intra or post-operative complications, stone free rate or duration of hospital stay. However, statistically significant longer operative time was recorded in UAS group compared to no UAS group. Conclusion our study showed that flexible ureterenoscopy without ureteral access sheath Seems to be safe as flexible ureterenoscopy with ureteral access sheath regards intraoperative, post- operative complications, patient satisfaction, stone free rate and duration of hospital stay, an additional advantage is shorter operative time without using of ureteral access sheath