Abstract：Objective: To summarize the rules of adaptation of ureteral access sheath (UAS) in flexible ureteroscopy (FURS) and guide clinical decision-making. Methods: We retrospectively evaluated the clinical data of 540 patients who underwent 609 cases of FURS from June 2014 to January 2016 in our hospital. The success rate of UAS insertion in indwelling double-J stent group (preset 2 weeks) and non-indwelling double-J stent group and relevant factors associated with the UAS placement were analyzed statistically. Results: In 609 cases of FURS, only 51 ones failed in the deployment of UAS with the fail rate of 8.4% (51/609) and the overall success rate was 91.6% (558/609). Furthermore, 303 cases of USA in indwelling double-J stent group were inserted successfully with a failure rate of 0% (0/303). Fifty-one in 306 cases of USA in non-indwelling double-J stent group fail in the placement, which accounted for 16.7%. The comparison of the successful insertion of UAS group with failed one revealed there was no significant difference (P>0.05) in age, sex, surgery side, BMI, comorbidities with hypertension and diabetes, but there was significant difference statistically between the two groups in the history of indwelling double-J stent and ipsilateral stone surgery (all P=0.000). Conclusions: Patients with a history of indwelling double-J stent and ipsilateral stone surgery had a higher success rate of UAS placement. The results of this study play an important role in preoperative communication and clinical decision-making.
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