The impact of ureteral access sheaths on radiation exposure in the ureterorenoscopic treatment of urolithiasis.

Introduction: Ureteral access sheaths (UAS) are widely used in the endoscopic treatment of urolithiasis. In modern medicine, radiation exposure from diagnostics and therapy is increasing; however, the impact of UAS on procedure duration, fluoroscopy time, and radiation exposure is still uncertain.

Methods: This retrospective study included 1,026 patients who received ureterorenoscopic treatment for urolithiasis between 2016 and 2018 at a large academic center. Patients were dichotomized according to the use of UAS, and propensity score matching was performed based on age, BMI and stone size. Patient demographics, stone size, radiographic density, perioperative complications, and postoperative outcome were assessed. Procedure time and radiation exposure, recorded as the fluoroscopy time and area dose product, were analyzed.

Results: In total, 300 patients were successfully matched to the cohort with UAS (n=150) and the cohort without UAS (n=150). Patients' demographics were similar for age, gender, BMI and ASA score (each p>0.05). Median stone size was 8mm and 7.5mm in the cohort with and without UAS (p=0.335). Procedure time showed no differences between the two cohorts (p=0.749). Fluoroscopy time and area dose product were significantly lower in patients treated with the use of UAS (p=0.004; p<0.001).

Conclusion: The use of a UAS does not prolong operation time in patients with equivalent stone burden. In addition, the use of a UAS reduces fluoroscopy time and radiation exposure. In the future, to reduce radiation exposure to the patient and medical staff, the use of a UAS should also be considered for limited stone disease.