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Purpose: The aim of this study was to compare the failure rates of insertion of a 10/12-Fr ureteral access sheath (UAS) during retrograde intrarenal surgery (RIRS) in cases with and without stones and to analyze the risk factors for UAS insertion failure. Materials and Methods: A total of 640 RIRS cases (538 with and 102 without stones) were evaluated. The primary outcome of interest was the failure rate of insertion of a 10/12-Fr UAS. Associated risk factors were assessed using univariate and multivariate logistic regression analyses. Propensity score (PS) matching and inverse probability of treatment weighting (IPTW) were used to ensure the robustness of the results. Results: The overall failure rate of 10/12-Fr UAS insertion in the cases without stones was significantly higher than that in the cases with stones (39.2% vs. 7.2%; p