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Luo D, Zhang J, Xie L, Wang R, Ren H, Shang Z, Li C, Liu C. Development and validation of a predictive model for failure of ureteral access sheath placement in patients with ureteral calculi. BMC Urol 2024; 24:220. [PMID: 39385156 PMCID: PMC11462699 DOI: 10.1186/s12894-024-01606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/27/2024] [Indexed: 10/11/2024] Open
Abstract
OBJECTIVE The Ureteral Access Sheath (UAS) has notable benefits but may fail to traverse the ureter in some cases. Our objective was to develop and validate a dynamic online nomogram for patients with ureteral stones who experienced UAS placement failure during retrograde intrarenal surgery (RIRS). METHODS This study is a retrospective cohort analysis using medical records from the Second Hospital of Tianjin Medical University. We reviewed the records of patients with ureteral stones who underwent RIRS in 2022 to identify risk factors associated with UAS placement failure. Lasso combined logistic regression was utilized to identify independent risk factors associated with unsuccessful UAS placement in individuals with ureteral stones. Subsequently, a nomogram model was developed to predict the likelihood of failed UAS placement in this patient cohort. The model's performance was assessed through Receiver Operating Characteristic Curve (ROC) analysis, calibration curve assessment, and Decision Curve Analysis (DCA). RESULTS Significant independent risk factors for unsuccessful UAS placement in patients with ureteral stones included age (OR = 0.95, P < 0.001), male gender (OR = 2.15, P = 0.017), body mass index (BMI) (OR = 1.12, P < 0.001), history of stone evacuation (OR = 0.35, P = 0.014), and ureteral stone diameter (OR = 0.23, P < 0.001). A nomogram was constructed based on these variables. Model validation demonstrated an area under the ROC curve of 0.789, indicating good discrimination. The calibration curve exhibited strong agreement, and the decision curve analysis revealed a favorable net clinical benefit for the model. CONCLUSIONS Young age, male sex, high BMI, no history of stone evacuation, and small diameter of ureteral stones were independent risk factors for failure of UAS placement in patients with ureteral stones, and the dynamic nomogram established with these 5 factors was clinically effective in predicting the outcome of UAS placement.
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Affiliation(s)
- Di Luo
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Jingdong Zhang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Linguo Xie
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Rui Wang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Haotian Ren
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Zhiqun Shang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Chunpeng Li
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Chunyu Liu
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China.
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Tefik T, Ergül RB, Osther P, Giusti G, Preminger GM, Straub M, Rassweiler JJ, Montanari E, Brehmer M, Seitz C, Grasso M, Pearle M, Proietti S, Cloutier J, Gunver MG, Nane I, Ozcan F, Traxer O. The relationship between the force applied and perceived by the surgeon during ureteral access sheath placement: ex-vivo experimental model. World J Urol 2024; 42:329. [PMID: 38753120 PMCID: PMC11098873 DOI: 10.1007/s00345-024-04982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To define a peak force of insertion (PFOI) threshold for ureteral damage during ureteral access sheath (UAS) placement on an experimental ureteral orifice model. METHODS A specially designed water tank using 2 laparoscopic 5 mm ports and 2 different size (10 Fr and 8 Fr) sealing cap adaptors (SCA) as ureteral orifices was used to perform the test. A 10-12 Fr UAS was fixed to a load cell and the force of insertion (FOI) was continuously recorded with a digital force gauge.13 experts in the field of endourology who participated performed 3 UAS insertions. The FOI was recorded initially with 10 Fr followed by 8 Fr SCA. On the final insertion, the orifice was obstructed, leaving a 5 cm length to insert the UAS. The experts were asked to "Stop at the point they anticipate ureteral damage, and they would not proceed in real life". RESULTS Using 10 Fr SCA the PFOI was 2.12 ± 0.58 Newton (N) (range:1.48-3.48) while 8 Fr SCA showed a PFOI 5.76 ± 0.96 N (range:4.05-7.35). Six of the experts, said they would stop proceeding when they reached above 5.1 N. Three experts had PFOI < 5.1 N and the other 4 stated they would go with PFOIs of 5.88, 6.16, 6.69 and 7.35 N when using SCA of 8 Fr.The highest load they would stop proceeding had a PFOI of 6.09 ± 1.87 N (range: 2.53-10.74). CONCLUSION The PFOI threshold for ureteral damage inserting UAS of the experts is variable. Although FOI is a subjective perception, experience suggests that ureteral injury may occur at an average of 6.05 N perceived by surgeons' tactile feedback. In-vivo measurement of UAS PFOI may confirm a threshold.
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Affiliation(s)
- Tzevat Tefik
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France.
| | - Rifat Burak Ergül
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Palle Osther
- Department of Urology, Urological Research Center, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | | | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marianne Brehmer
- Department of Urology, Stockholm South General Hospital Stockholm, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Stockholm South General Hospital Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Grasso
- Department of Urology, Phelps Hospital/Northwell Health, New York, USA
| | | | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jonathan Cloutier
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - MGuven Gunver
- Department of Medical Statistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismet Nane
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Olivier Traxer
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
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O'Meara S, Cunnane EM, Croghan SM, Cunnane CV, Walsh MT, O'Brien FJ, Davis NF. Mechanical characteristics of the ureter and clinical implications. Nat Rev Urol 2024; 21:197-213. [PMID: 38102385 DOI: 10.1038/s41585-023-00831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/17/2023]
Abstract
The ureteric wall is a complex multi-layered structure. The ureter shows variation in passive mechanical properties, histological morphology and insertion forces along the anatomical length. Ureter mechanical properties also vary depending on the direction of tensile testing and the anatomical region tested. Compliance is greatest in the proximal ureter and lower in the distal ureter, which contributes to the role of the ureter as a high-resistance sphincter. Similar to other human tissues, the ureteric wall remodels with age, resulting in changes to the mechanical properties. The passive mechanical properties of the ureter vary between species, and variation in tissue storage and testing methods limits comparison across some studies. Knowledge of the morphological and mechanical properties of the ureteric wall can aid in understanding urine transport and safety thresholds in surgical techniques. Indeed, various factors alter the forces required to insert access sheaths or scopes into the ureter, including sheath diameter, safety wires and medications. Future studies on human ureteric tissue both in vivo and ex vivo are required to understand the mechanical properties of the ureter and how forces influence these properties. Testing of instrument insertion forces in humans with a focus on defining safe upper limits and techniques to reduce trauma are also needed. Last, evaluation of dilatation limits in the mid and proximal ureter and clarification of tensile strength anisotropy in human specimens are necessary.
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Affiliation(s)
- Sorcha O'Meara
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland.
| | - Eoghan M Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland
| | - Connor V Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Michael T Walsh
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Niall F Davis
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
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De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebø-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX. Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med 2022; 11:jcm11175128. [PMID: 36079058 PMCID: PMC9456781 DOI: 10.3390/jcm11175128] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Correspondence: ; Tel.: +32-3-650-50-56
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ioannis Mykoniatis
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Belthangady M. Zeeshan Hameed
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Campus Bio-Medico University, 00128 Rome, Italy
- Unit of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Olivier Traxer
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Hu J, Yu Y, Liu W, Zhong J, Zhou X, Xi H. Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement. Int J Clin Pract 2022; 2022:7518971. [PMID: 36120665 PMCID: PMC9467721 DOI: 10.1155/2022/7518971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. METHODS We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. RESULTS Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p=0.013), length of history 15-31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p=0.045), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p=0.023), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p=0.035) were associated with UAS placement. CONCLUSION Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.
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Affiliation(s)
- Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialei Zhong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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