A ureteral access sheath is a supportive instrument used in endourology to establish and maintain a protected working channel through the ureter, facilitating repeated instrument passage during procedures such as flexible ureteroscopy. This overview summarizes general design concepts, referencing INVAMED's ureteral access sheath offering within the Bionovus line, for healthcare professionals; it does not replace the applicable IFU.
What Problem Does a Ureteral Access Sheath Address?
During endourological procedures, instruments — including the ureteroscope itself, laser fibers, and stone extraction baskets — may need to pass in and out of the ureter multiple times. Repeated instrument passage without a protective sheath can increase friction and the potential for mucosal trauma to the ureteral wall. A ureteral access sheath is designed to address this by providing a continuous, protected working channel, intended to reduce the potential for trauma during repeatable instrument exchange.
What Is the General Design and Function?
The sheath consists of an outer, protective conduit placed within the ureter over a previously established guidewire and dilation system, creating a stable passage from outside the body into the ureter (and, depending on positioning, toward the renal pelvis). This is intended to allow the endoscope and other instruments to be introduced and withdrawn multiple times during a single procedure without repeated direct contact between the instrument and the unprotected ureteral wall.
What Coating and Compatibility Features Are Relevant?
A hydrophilic coating is a common design feature intended to ease sheath insertion and navigation, particularly in cases described as more difficult passage, by reducing surface friction during placement. Ureteral access sheaths are generally designed for use with Amplatz-type dilators and/or balloon dilators, which are used beforehand to progressively and atraumatically dilate the ureteral entry point before the sheath itself is advanced into position.
Why Does Sheath Use Matter for Procedural Efficiency?
By maintaining a stable working channel, an access sheath is intended to support easier access during more complex or extended endourological procedures, potentially reducing cumulative procedure time associated with repeated unassisted instrument passage. This is particularly relevant in procedures involving multiple passes for stone fragment retrieval or laser lithotripsy across a larger stone burden.
What Procedural and Risk Considerations Apply?
As with any ureteral instrumentation, access sheath placement carries potential risks, including ureteral mucosal injury, and sheath diameter and length should be selected based on individual ureteral anatomy. Some clinicians reserve access sheath use for specific case types based on anticipated procedure complexity and institutional protocol. Clinicians should consult the applicable IFU for complete sizing, compatibility, and handling information, and device selection remains at the discretion of the treating physician.
Frequently Asked Questions
Is a ureteral access sheath required for every ureteroscopy?
No. Use is generally determined by anticipated procedure complexity, stone burden, and physician preference rather than being mandatory for every case.
How is sheath size selected for a given patient?
Sheath diameter and length are selected based on ureteral anatomy and the instruments anticipated for use during the procedure, following physician judgment and the applicable product catalog.
Does the hydrophilic coating affect sheath handling during the procedure?
The coating is intended to ease initial insertion by reducing friction; handling characteristics during the remainder of the procedure should be confirmed against the applicable IFU and clinician experience.
Related INVAMED Resources
- StoneMaster Nitinol Stone Extraction Basket Overview
- Who Is a Candidate for Ureteroscopy? FAQs
- Urology & Incontinence Management products
Medical Disclaimer: This article is provided for general informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendation. It is not a substitute for consultation with a qualified healthcare professional. Product indications, availability, and regulatory status vary by country. Always refer to the official Instructions for Use (IFU) and consult a licensed physician for guidance specific to your situation. INVAMED devices are intended for use by trained healthcare professionals.