Ureteral Access Sheaths: a Comprehensive Comparison of Physical and Mechanical Properties

Overview

Journal Int Braz J Urol

Specialty Urology

Date 2018 Mar 2

PMID 29493185

Citations 7

Authors

Nishant Patel

Manoj Monga

Affiliations

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Abstract

Introduction: Ureteral access sheaths (UAS) facilitate flexible ureteroscopy in the treatment of urolithiasis. The physical properties of UAS vary by manufacturer and model. We compared three new UAS: Glideway (GW, Terumo, 11/13Fr, 12/14Fr), Pathway (PW, Terumo 12/14F) and Navigator HD (NHD, Boston Scientific, 11/13Fr, 12/14Fr) in the domains of safety characteristics, positioning characteristics, lubricity and radioopacity.

Materials And Methods: In vitro testing of the three UAS included safety testing-tip perforation force, sheath edge deformation and dilator extraction forces. Positioning characteristics tested included tip bending, stiffness (resistance to coaxial buckling forces), kinking (resistance to perpendicular forces), and insertion forces. Lubricity was assessed by measured frictional forces of the outer sheath. Finally, radio-opacity was tested utilizing fluoroscopic imaging of the three 12F sheaths and inner dilators.

Results: The PW (0.245 lb) and GW (0.286 lb) required less force for tip perforation compared to the NHD (0.628 lb). The NHD sheath edge deformation was mild compared to more severe deformation for the PW and GW. The PW (1.008 lb) required greater force than the GW (0.136 lb) and NHD (0.043 lb) for inner dilator removal. The GW (3.69 lbs) and NHD (4.17 lb) had similar inner dilator tip stiffness when bent, while the PW had the weakest inner dilator tip, 1.91 lbs. The PW (0.271 lb) was most susceptible to buckling and kinking (1.626 lb). The most lubricious UAS was the NHD (0.055 lbs for 12F). The NHD (0.277 lbs) required the least insertional force through a biological model and possessed the greatest radio-opacity.

Conclusions: Comparison of different commercially available UAS in various sizes reveals that there are mechanical differences in sheaths that may play a role clinically. The Terumo sheaths' (GW and PW) were outperformed by the Boston Scientific NHD in simulating safety, ease of use and radio-opacity.

Citing Articles

The effect of distal ureteral lateralization angle on ureteral trauma avoidance and successful ureteral access sheath placement.

Yigman M, Colakoglu Er H Ulus Travma Acil Cerrahi Derg. 2024; 30(9):671-676.

PMID: 39222492 PMC: 11622716. DOI: 10.14744/tjtes.2024.67996.

Postoperative Renal Abscess Following Tip-Flexible Suctioning Ureteral Access Sheath and Digital Ureteroscopic Lithotripsy: A Case Report.

Xiong L, Kwan K, Wei G, Xu X, Lu Z Am J Case Rep. 2024; 25:e944782.

PMID: 39152632 PMC: 11334673. DOI: 10.12659/AJCR.944782.

Mechanical characteristics of the ureter and clinical implications.

OMeara S, Cunnane E, Croghan S, Cunnane C, Walsh M, OBrien F Nat Rev Urol. 2023; 21(4):197-213.

PMID: 38102385 DOI: 10.1038/s41585-023-00831-1.

Effective ureteral access sheath insertion during flexible ureteroscopy: Influence of the ureteral orifice configuration.

Azhar R, Alghamdi M, Khawaji A, Nassir A, Munshi S, Tayeb W Can Urol Assoc J. 2022; 16(7):E375-E380.

PMID: 35230939 PMC: 9328857. DOI: 10.5489/cuaj.7656.

Does ureteral access sheath have an impact on ureteral injury?.

Asutay M, Lattarulo M, Liourdi D, Al-Aown A, Pagonis K, Nedal N Urol Ann. 2022; 14(1):1-7.

PMID: 35197695 PMC: 8815358. DOI: 10.4103/UA.UA_163_20.

References

Auge B, Pietrow P, Lallas C, Raj G, Santa-Cruz R, Preminger G . Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004; 18(1):33-6. DOI: 10.1089/089277904322836631. View

Delvecchio F, Auge B, Brizuela R, Weizer A, Silverstein A, Lallas C . Assessment of stricture formation with the ureteral access sheath. Urology. 2003; 61(3):518-22; discussion 522. DOI: 10.1016/s0090-4295(02)02433-0. View

Rehman J, Monga M, Landman J, Lee D, Felfela T, Conradie M . Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003; 61(4):713-8. DOI: 10.1016/s0090-4295(02)02440-8. View

Pedro R, Hendlin K, Durfee W, Monga M . Physical characteristics of next-generation ureteral access sheaths: buckling and kinking. Urology. 2007; 70(3):440-2. DOI: 10.1016/j.urology.2007.04.043. View

Al-Qahtani S, Letendre J, Thomas A, Natalin R, Saussez T, Traxer O . Which ureteral access sheath is compatible with your flexible ureteroscope?. J Endourol. 2013; 28(3):286-90. DOI: 10.1089/end.2013.0375. View

Pietrow P, Auge B, Delvecchio F, Silverstein A, Weizer A, Albala D . Techniques to maximize flexible ureteroscope longevity. Urology. 2002; 60(5):784-8. DOI: 10.1016/s0090-4295(02)01948-9. View

Kourambas J, Byrne R, Preminger G . Does a ureteral access sheath facilitate ureteroscopy?. J Urol. 2001; 165(3):789-93. View

Newman R, Hunter P, Hawkins I, Finlayson B . The ureteral access system: a review of the immediate results in 43 cases. J Urol. 1987; 137(3):380-3. DOI: 10.1016/s0022-5347(17)44039-0. View

Vanlangendonck R, Landman J . Ureteral access strategies: pro-access sheath. Urol Clin North Am. 2004; 31(1):71-81. DOI: 10.1016/S0094-0143(03)00095-8. View

10.

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. 2012; 189(2):580-4. DOI: 10.1016/j.juro.2012.08.197. View

11.

De S, Sarkissian C, Torricelli F, Brown R, Monga M . New ureteral access sheaths: a double standard. Urology. 2015; 85(4):757-63. DOI: 10.1016/j.urology.2014.07.009. View

12.

LEsperance J, Ekeruo W, Scales Jr C, Marguet C, Springhart W, Maloney M . Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology. 2005; 66(2):252-5. DOI: 10.1016/j.urology.2005.03.019. View

13.

Portis A, Rygwall R, Holtz C, Pshon N, Laliberte M . Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup. J Urol. 2006; 175(6):2129-33. DOI: 10.1016/S0022-5347(06)00311-9. View

14.

Monga M, Bhayani S, Landman J, Conradie M, Sundaram C, Clayman R . Ureteral access for upper urinary tract disease: the access sheath. J Endourol. 2001; 15(8):831-4. DOI: 10.1089/089277901753205843. View

15.

Geavlete P, Georgescu D, Nita G, Mirciulescu V, Cauni V . Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol. 2006; 20(3):179-85. DOI: 10.1089/end.2006.20.179. View