Assessing Flexible Ureteroscopy Outcomes for Lower Pole Versus Non Lower Pole Stones Using the Flexible and Navigable Suction Ureteric Access Sheath: a Prospective Multicenter Study by EAU Endourology and PEARLS Group

Overview

Journal World J Urol

Specialty Urology

Date 2024 Dec 20

PMID 39704866

Authors

Anil Shrestha

Olivier Traxer

Christian Seitz

Mariela Corrales

Daniele Castellani

Ben Hall Chew

Deepak Ragoori

Udita Mishra

Saeed Bin Hamri

Karl Marvin Tan

Steffi Kar Kei Yuen

Akash Chitrakar

Etienne Xavier Keller

Bhaskar Kumar Somani

Vineet Gauhar

Affiliations

Soon will be listed here.

Abstract

Purpose: Use of suction in flexible ureteroscopy is increasing lately. The introduction of flexible and navigable suction access sheath (FANS) has shown improved stone free rate (SFR). However, its efficacy in lower pole stone (LPS) in terms of SFR and complications is yet to be studied.

Methods: We collected data from 25 centers that included 394 adult patients undergoing ureteroscopy using FANS. Non contrast CT (NCCT) scan was done within first 30 days post operatively to access the SFR. Residual fragments were graded as A: 100% SFR; B: single fragment ≤ 2 mm; C: single fragment 2.1-4 mm; D: Single or multiple fragments > 4 mm. Post operative complications were recorded.

Results: Out of 394 patients, non LPS (group1) comprised of 268 patients, rest 126 patients had LPS (group 2). Single stage zero fragment SFR was seen in 58.6% (group 1) vs. 54.8% (group 2) (P = 0.619). Single stage grade A + B SFR was achieved in 96.6% vs. 98.4% in groups 1 and 2 respectively. On multivariate analysis Thulium fiber laser use was significantly associated with higher odds of being grade A stone-free, while stone volume with lower odds. In LPS group only two patients needed reintervention. The highest grade of complication was Clavien 2, which was seen in 3.2% LPS group.

Conclusion: Use of flexible and navigable suction ureteric access sheath for lower pole stones is effective and safe. The stone free rate of lower pole stones is comparable to non-lower pole locations with very low reintervention rate in both groups.

Citing Articles

The utility of flexible and navigable suction access sheath (FANS) in patients undergoing same session flexible ureteroscopy for bilateral renal calculi: a global prospective multicenter analysis by EAU endourology.

Gauhar V, Somani B, Castellani D, Fong K, Gadzhiev N, Persaud S World J Urol. 2025; 43(1):142.

PMID: 40019574 PMC: 11870961. DOI: 10.1007/s00345-025-05477-9.

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