Failed insertion of ureteral access sheath during flexible ureterorenoscopy: A randomized controlled trial comparing second session flexible ureterorenoscopy or same session mini percutaneous nephrolithotomy

We aimed to compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session. Patients with kidney stones measuring 1-2 cm, presented to our urology clinic between April 2019 and April 2021, were included in the study for evaluation. Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, ureteral JJ stent was placed for dilation and second session of f-URS was planned 4-6 weeks later. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session. Pre-operative demographic data, operative and post-operative characteristics including complications and success rates were compared. Patients were assessed by Short-Form-36 (SF-36) questionnaires to compare overall life quality after each procedure. Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group (p:0.001, p:0.001 and p:0.001, respectively). When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group (p:0.026 and p:0.017).In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4-6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time. Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.