Novel curved ureteric access sheath holds the potential to aid anatomical placement and allow adjustment in the renal pelvis: a feasibility study

Abstract

Background: The benefits of ureteric access sheath (UAS) placement during flexible ureterorenoscopy (fURS) for urolithiasis are well recognised. Failure to successfully place a UAS and the potential for ureteric injury are known complications. This feasibility study aims to describe a novel curved UAS, which is postulated to assist the endourologist in negotiating the anatomy of the ureter more easily and to enhance drainage from the kidney.

Methods: The curved UASs were all 35 cm in length and 11/13 French in diameter. The long axis of the curved UAS to the axis of the terminal curved part is 140–150 degrees. This feasibility study consisted of the placement of a curved UAS under fluoroscopy followed by the routine dissection of the kidneys of two adult human cadavers.

Results: Placement in the urinary tract of the curved UAS may be facilitated by the ability to rotate the UAS during retrograde passage over a guidewire. The ability of the curved UAS to be placed in the renal pelvis in an anatomically congruent manner holds the potential to facilitate the targeting of calyxes during fURS.

Conclusion: This paper described a novel curved UAS. Cadaveric kidney observation suggests that UAS introduction may be easier and allow greater targeting of calyceal anatomy during fURS. These postulates deserve investigation in a pilot clinical trial.