MP10-11 A NOVEL SINGLE-STEP PERCUTANEOUS AC-CESS SHEATH: COMPARISON OF FIRST AND SECOND GEN-ERATION DEVICES

Introduction: A novel single-step percutaneous access sheath (NS1) wasdeveloped to allow insertion of a dilating balloon and a renal access sheathin a single step. This device was modified (NS2) to include a more taperedtip to allow easier insertion. This study reviews patients treated with thefirst and second generations of this device.Method: A retrospective chart and database review of the initial 75 con-secutive patients undergoing percutaneous nephrostolithotomy using theNS (41 NS1 and 34 NS2) was performed. Data collected included patientdemographics, operative and recovery parameters, complications and de-vice failures.Result: Mean patient age was 50.5 years (range 11-84 years), mean BMIwas 30.2 (range 17.1-59.8), and mean stone area was 9.5 cm2 (range 1-36 cm2). Twenty-four patients had full staghorn calculi. Mean operativetime was 136.0 min (range 39-345 min). The mean estimated blood losswas 142cc (range 5-1000cc), and transfusion rate was 5.8%. Medianpostoperative hospital stay was 4 days (range 1-23 days). 72% of pa-tients required one procedure while 25% required two procedures. De-vice failure rate was compared between NS1 (2.4%) and NS2 (14.7%).The only insertion failure in NS1 group was due to buckling. Devicefailure in NS2 resulted from incomplete expansion (2), balloon rupture(2), and kinking (1).Conclusion: Although the second-generation sheath was easier to insert,device and balloon failures were more frequent. Modifications to pre-serve insertion ease while increasing balloon and sheath reliability arenecessary.