Purpose To compare peri- and postoperative outcomes of non-suction conventional ureteral access sheath (CUAS) versus flexible and navigable suction ureteral access sheaths (FANS) in retrograde intra-renal surgery (RIRS) for renal stones. Methods In this multicentric, real world, prospective study, 529 adult patients undergoing RIRS across 19 centers were enrolled between August 2023 and January 2024. Of these, 263 underwent RIRS using FANS and 265 with CUAS. After propensity score matching (PSM) for age, gender, and stone volume, 184 patients per group were match paired for analysis. Outcomes included stone-free rate (SFR), intraoperative parameters, and postoperative complications assessed within 30 days. Results Post-PSM, baseline characteristics were well-balanced. The FANS group demonstrated significantly longer lasing (17.94 vs. 15.28 min, p = 0.017) and ureteroscopy time (37.48 vs. 30.08 min, p < 0.001), but similar total surgical time. The use of stone retrieval baskets and postoperative stenting was significantly lower in the FANS group (p < 0.001). The 30 day stone free rate was significantly higher with FANS (98.9% vs. 89.1%, p < 0.001) and lower re-operation rates (16.3% vs. 71.0%, p = 0.009). The incidence of postoperative pain was significantly lower in the FANS group (0.0% vs. 14.1%, p < 0.001), potentially due to reduced calyceal overdistension and lower rates of ureteral stenting (70.7% vs. 99.5%, p < 0.001) The overall complications rates were low and comparable between groups. Conclusions The higher 30-day stone-free rate and lower reintervention rates with FANS suggest better outcomes over conventional UAS RIRS. The reduced use of baskets and accessories make FANS a useful intraoperative tool for those performing RIRS with access sheaths. Along with low postoperative pain and the absence of a need for postoperative stenting in select FANS patients collectively, these findings favor using FANS with appropriate training over CUAS.
Flexible ureteroscopy for renal stones comparing non suction conventional UAS vs flexible and navigable suction ureteral access sheaths in a multicenter real-world experience. Is it finally time to bury the no suction ureteral access sheath? An EAU endourology analysis
Castellani D;
2025-01-01
Abstract
Purpose To compare peri- and postoperative outcomes of non-suction conventional ureteral access sheath (CUAS) versus flexible and navigable suction ureteral access sheaths (FANS) in retrograde intra-renal surgery (RIRS) for renal stones. Methods In this multicentric, real world, prospective study, 529 adult patients undergoing RIRS across 19 centers were enrolled between August 2023 and January 2024. Of these, 263 underwent RIRS using FANS and 265 with CUAS. After propensity score matching (PSM) for age, gender, and stone volume, 184 patients per group were match paired for analysis. Outcomes included stone-free rate (SFR), intraoperative parameters, and postoperative complications assessed within 30 days. Results Post-PSM, baseline characteristics were well-balanced. The FANS group demonstrated significantly longer lasing (17.94 vs. 15.28 min, p = 0.017) and ureteroscopy time (37.48 vs. 30.08 min, p < 0.001), but similar total surgical time. The use of stone retrieval baskets and postoperative stenting was significantly lower in the FANS group (p < 0.001). The 30 day stone free rate was significantly higher with FANS (98.9% vs. 89.1%, p < 0.001) and lower re-operation rates (16.3% vs. 71.0%, p = 0.009). The incidence of postoperative pain was significantly lower in the FANS group (0.0% vs. 14.1%, p < 0.001), potentially due to reduced calyceal overdistension and lower rates of ureteral stenting (70.7% vs. 99.5%, p < 0.001) The overall complications rates were low and comparable between groups. Conclusions The higher 30-day stone-free rate and lower reintervention rates with FANS suggest better outcomes over conventional UAS RIRS. The reduced use of baskets and accessories make FANS a useful intraoperative tool for those performing RIRS with access sheaths. Along with low postoperative pain and the absence of a need for postoperative stenting in select FANS patients collectively, these findings favor using FANS with appropriate training over CUAS.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
