Reports in the literature describe instances in which sheath placement was unsuccessful, advocating the use of preoperative alpha-blockers or even prestenting as potential strategies. Nevertheless, reported failure rates vary substantially. In our experience, however, sheath placement failure appeared to be exceedingly infrequent, which led us to hypothesize that routine administration of alpha-blockers to all patients undergoing flexible ureteroscopy might not be warranted. To test this, we retrospectively reviewed our outcomes, confirming a low failure rate of 2.31% across 177 procedures analyzed.
As noted in the study, 41 patients were excluded due to incomplete data, which would have compromised statistical analysis. Within this excluded cohort, sheath placement failed in only one case (2.4%), a rate consistent with the results observed in the main cohort.
Additionally, we are currently conducting a prospective study addressing this topic. Preliminary findings from that investigation further corroborate the low rate of ureteral access sheath placement failure.
So, considering these outcomes, we understand that it is not necessary to use some preoperative measures to reduce the failure rate of inserting the ureteral access sheath.
Written by: Antonio Corrêa Lopes Neto, PhD, and Sidney Glina, PhD
- Department of Urology, Centro Universitário FMABC, Santo André, SP, Brazil