Editorial Comment : “Should Ureteral Access Sheaths Be Used Routinely for Ureteroscopy?”

The arguments presented by the authors on both sides of this point/counterpoint reveal how, despite strongly held preferences by most stone surgeons, there is not overwhelming evidence on either side supporting sheath versus no sheath or their corollaries, basketing versus dusting. It is often said that “if there is more than one way to do a surgery, it's usually because nothing is really that great.” Both authors cite many of the same studies concerning stone-free rates after ureteroscopy as supporting the decision to use or not use an access sheath, but the real take-home message from these investigations is the rather dismal “CT-based true stone free rates” of <60% regardless of approach.

We as experts in stone disease need to evaluate what goal we are striving for, be it stone-free status or some other endpoint such as improved quality of life and fewer symptomatic events, and how to adequately measure how variations in technique affect those outcomes. It is time to shift away from accepting studies that report stone-free rates with anything but CT scan data and embrace those that report alternative endpoints.