To sheath or not to sheath in flexible ureteroscopy: A randomized controlled trial.

Objective: To assess the effect of employing UAS compared to not using UAS in FURS concerning stone-free rate, operative duration, and intraoperative and postoperative complications. Methods: A total of 120 patients presenting with symptomatic upper ureteric and renal stones were recruited and allocated into two equal groups. Group A underwent flexible ureteroscopy (FURS) without using ureteral access sheaths (UAS), while Group B underwent FURS with UAS. Results: There were no statistically significant differences among the groups for the Stone-free rate, operative duration, length of hospital stay, and postoperative pain, with p-values of 0.543, 0.122, 0.639, and 0.083, respectively. However, group A experienced a significantly higher occurrence of postoperative complications, affecting 14 patients (23.3%), compared to five patients (8.3%) in group B, with a p-value of less than 0.05. These complications mainly presented as postoperative fever and urosepsis. Conclusion: Utilizing UAS alongside Flexible ureteroscopy had no impact on stone-free rate, operative time, hospital stay, or intraoperative complications. However, it notably lowered postoperative infective complications.