EFFECTIVENESS OF URETERIC ACCESS SHEATH ON OUTCOMES OF RETROGRADE INTRARENAL SURGERY FOR RENAL PELVIC STONES

Abstract

Background: Renal stone disease affects approximately 10–15% of the global population, with an increasing incidence attributed to sedentary lifestyles and poor hydration. Men face a lifetime risk of 8–12%, while women have a risk of 5–7%. Without intervention, recurrence can reach up to 50% within ten years. Retrograde intrarenal surgery (RIRS) has emerged as a minimally invasive, effective treatment for stones <2 cm. The role of the ureteral access sheath (UAS) in optimizing outcomes during RIRS, however, remains a subject of ongoing clinical debate.

Objective: To evaluate the effectiveness of the ureteral access sheath (UAS) in enhancing operative outcomes of retrograde intrarenal surgery (RIRS) for renal stone disease.

Methods: This descriptive comparative study was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar, from March to August 2024, following ethical approval (Ref No. 460/Chairman/R&E/Committee). A total of 152 patients with radiologically confirmed renal stones measuring 10–20 mm were enrolled and randomized into two groups: RIRS with UAS (n=76) and RIRS without UAS (n=76). Inclusion and exclusion criteria were applied. All procedures were performed by a consultant urologist under standardized conditions. Outcomes assessed included operative time, hospital stay, intra/postoperative complications, and stone clearance. Data were analyzed using SPSS version 22.0, with a p-value ≤ 0.05 considered significant.

Results: The mean age was 36.8 ± 11.4 years, with 66.4% male and 33.6% female patients. Stones were located in the renal pelvis in 80.3% of cases, with a mean size of 14.1 ± 2.9 mm. The average operative time was 31.5 ± 9.3 minutes. Overall, the stone clearance rate was 87.5%. Patients in the UAS group had significantly higher clearance (92.1% vs. 78.9%, p=0.04), shorter hospital stay (1.1 ± 0.3 vs. 1.3 ± 0.5 days, p=0.01), but a higher complication rate (19.7% vs. 9.2%, p=0.03) compared to the non-UAS group.

Conclusion: UAS use during RIRS was associated with improved stone clearance and reduced hospitalization, reinforcing its clinical utility. However, the elevated complication rate warrants cautious use and further research to define its role in specific patient subgroups.