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  • Review Article
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Use of ureteral access sheaths in ureteroscopy

Nature Reviews Urology volume 13, pages 135–140 (2016)Cite this article

Subjects

Key Points

  • A ureteral access sheath (UAS) enables the urologist to repeatedly pass the ureteroscope into the upper ureter and kidney, without a need to pass the ureteroscope over a working wire

  • The ureteral access sheath (UAS) has a hydrophilic coating and is designed to be resistant to kinking and buckling during retrograde passage into the ureter

  • Use of a UAS improves the flow of irrigation fluid and visualization within the ureter, reduces operative times and overall costs and improves the effectiveness of surgery

  • Use of a UAS can cause injury to the ureter, might increase the risk of ureteral wall ischaemia, and, theoretically, carries an increased risk of ureteral strictures

  • To minimize the risk of postoperative complications, a ureteral stent is typically placed at the end of a procedure in which a UAS has been used

Abstract

The ureteral access sheath (UAS) facilitates the use of flexible ureteroscopy, enabling improved minimally invasive management of complex upper urinary tract diseases. The UAS, which comes in a variety of diameters and lengths, is passed in a retrograde fashion, aided by a hydrophilic coating and other features designed to confer smooth passage into the ureter with sufficient resistance to kinking and buckling. Use of a UAS has the advantage of enabling repeated passage of the ureteroscope while minimizing damage to the ureter, thus improving the flow of irrigation fluid and visualization within the urethra with reductions in operative times, which improves both the effectiveness of the surgery and reduces the costs. Placement of the UAS carries an increased risk of ureteral wall ischaemia and injury to the mucosal or muscular layers of the ureter, and a theoretically increased risk of ureteral strictures. A ureteral stent is typically placed after ureteroscopy with a UAS. Endourologists have found several additional practical uses of a UAS, such as the percutaneous treatment of patients with ureteral stones, and solutions to other endourological challenges.

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Figure 1: The ureteral access sheath.
Figure 2: Advancement of a ureteroscope within the ureter.

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Author information

Authors and Affiliations

  1. Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, 27710, North Carolina, USA

    Adam G. Kaplan, Michael E. Lipkin, Charles D. Scales Jr & Glenn M. Preminger

Authors
  1. Adam G. Kaplan
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  3. Charles D. Scales Jr
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  4. Glenn M. Preminger
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Contributions

All authors made a substantial contribution to researching data for this article and discussions of content, A.G.K. and G.M.P. wrote the manuscript, M.E.L., C.D.S. and G.M.P. edited and/or reviewed the manuscript prior to submission.

Corresponding author

Correspondence to Glenn M. Preminger.

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Competing interests

M.E.L. and G.M.P. have acted as consultants for Boston Scientific and Olympus. The other authors declare no competing interests.

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Kaplan, A., Lipkin, M., Scales, C. et al. Use of ureteral access sheaths in ureteroscopy. Nat Rev Urol 13, 135–140 (2016). https://doi.org/10.1038/nrurol.2015.271

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