Pd23-10 Ureteroscope Reprocessing: A Time-in-Motion Study of a Lengthy Journey

crossed over to the other sheath for a trial of passage and excluded from video review.RESULTS: Patients had a mean cumulative stone diameter of 13.1Æ10.9mmand stone surface area burden of 1165Æ1065mm 2 .The success rate for initial sheath placement was 86.6%; placement rate and did not differ for sheaths groups.In no case did the Flexor sheath advance where the Navigator had failed while the Navigator was successful in passage in 50% (3/6) of the Flexor failures.The Navigator HD was subjectively rated as easier to place (3.4 vs 2.9, p¼0.029).Grade 1 injury was seen in 24.6%, grade 2 in 11.5% and grade 3 in 6.5%; there was no difference in rate of injury between sheaths.There were no grade 4 injuries.Male gender, large stone burden, longer time of sheath insertion and a more difficult subjective rating for sheath placement were associated with high grade (grade 2 or 3) ureteral injury.Postoperative complication rate was 11.1% and similar between zero/low and high grade injury groups.CONCLUSIONS: No significant difference in the risk of ureteral wall injury was noted between the two sheaths tested.Both a subjectively difficult sheath placement and a longer time of placement were associated with high grade injury, suggesting that surgeons should carry a low threshold for switching to a smaller sheath when resistance is felt.Though ureteral wall injury was not associated with any perioperative complications, long-term follow-up will be required to monitor for risk of stricture formation.