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Advances in Urology
Volume 2016 (2016), Article ID 6267953, 5 pages
Review Article

The Single Wire Ureteral Access Sheath, Both Safe and Economical

Columbia University Division of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL 33140, USA

Received 15 July 2016; Accepted 19 October 2016

Academic Editor: Jason M. Hafron

Copyright © 2016 Joan C. Delto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Novel disposable products for ureteroscopy are often inherently more expensive than conventional ones. For example, the Cook Flexor© Parallel™ (Flexor) access sheath is designed for ease and efficiency of gaining upper tract access with a solitary wire. We analyze the cost combinations, efficiency, and safety of disposable products utilized for upper tract access, including the Flexor and standard ureteral access sheath. Methods. We performed a retrospective review from January 2014 to October 2014 of patients undergoing URS for nephrolithiasis, who were prestented for various reasons (e.g., infection). Common combinations most utilized at our institution include “Classic,” “Flexor,” and “Standard.” Total costs per technique were calculated. Patient characteristics, operative parameters, and outcomes were compared among the groups. Results. The most commonly used technique involved a standard ureteral sheath and was the most expensive ($294). The second most utilized and least expensive combination involved the Flexor, saving up to $80 per case (27%). All access sheaths were placed successfully and without complications. There were no significant differences in operative time, blood loss, or complications. Conclusions. In prestented patients within this study, the Flexor combination was the most economical. Although the savings appear modest, long-term impact on costs can be substantial.