Safety and efficacy of sequential balloon dilation prior to ureteral access sheath insertion in nonstented patients undergoing ureteroscopy.

Techniques such as ureteral access sheath placement and balloon dilation are utilized to facilitate ureteroscopy. A retrospective review was performed to evaluate the efficacy and complications from ureteral access sheath (UAS) placement with or without sequential ureteral balloon dilation (SBD) in non-prestented patients who underwent ureteroscopy with UAS with or without SBD for renal or proximal ureteral stones from February 2014 to April 2017. This was a two-surgeon series of 124 patients divided into groups of SBD + UAS or direct UAS placement. Postoperative complications included hematuria, fever, and flank pain. Successful UAS insertion rates and postoperative complication rates were statistically significantly higher in the SBD + UAS group (P = 0.01 and 0.023, respectively). The procedure time, emergency department return, and 6-week stone-free rates were not statistically different between the groups. In conclusion, SBD + UAS has a higher success rate of UAS insertion compared to direct UAS alone, allowing for same-setting ureteroscopy. However, SBD + UAS is associated with significantly higher rates of fever, flank pain, and hematuria. We conclude that SBD + UAS and direct UAS are equivalent.