Background: Flexible and Navigable Suction Ureteral Access Sheath (FANS) revolutionized flexible ureteroscopy for stone management. This study assessed outcomes using a standardized FANS classification across different ureteroscope-sheath combinations. Methods: We prospectively enrolled 862 adult patients from 21 centers (June-September 2025), stratifying patients into three groups: group 1 (ultra-mini: 6.3 Fr scope/<10 Fr FANS, N.=203, 23.5%), group 2 (mini: 7.5-8 Fr scope/10-12 Fr FANS, N.=446, 51.7%), and group 3 (Standard: >8 Fr scope/11-13 or 12-14 Fr FANS, N.=213, 24.7%). Stone-free rate (SFR) was classified on 30-day CT as grade A (zero residual fragment, ZRF), grade B (single RF≤2mm), grade C (single RF 2.1-4mm), grade D (single/multiple RF>4mm). Results: Age, gender, Body Mass Index, comorbidities and stone volume were similar across all groups. Overall complications occurred in 21.6% of group 3, 5.8% in group 2, and 10.8% in group 1 (P<0.001). Ureteric injury was more frequent in group 3 (15.5%) than groups 1 (2.5%) and 2 (2.2%, P<0.001). On multivariable analysis, group 3 had significantly lower odds of ZRF (OR 0.38, 95% CI 0.23-0.62, P<0.001) compared to group 1. Grades A+B SFR was 86.3%, with ZRF achieved in 76.5% overall. Group 2 demonstrated superior ZRF rates (80.5%) compared to group 1 (77.8%) and group 3 (65.4%, P<0.001). Grade D was significantly higher in group 3 (14.8%) versus group 2 (5.9%) and group 1 (4.4%). Conclusions: Ultra-mini and mini-FANS demonstrate superior safety profiles and SFRs compared to standard FANS, with mini-FANS achieving optimal outcomes.
A prospective multicenter study of Flexible ureteroscopy using different flexible and navigable suction access sheath (FANS) sizes: peri and 30-day postoperative outcomes from the global and prospective multicenter FLEXible ureteroscopy Outcomes Registry using FANS (FLEXOR-F) by the EAU section of endourology
CASTELLANI, DanieleMembro del Collaboration Group
2026-01-01
Abstract
Background: Flexible and Navigable Suction Ureteral Access Sheath (FANS) revolutionized flexible ureteroscopy for stone management. This study assessed outcomes using a standardized FANS classification across different ureteroscope-sheath combinations. Methods: We prospectively enrolled 862 adult patients from 21 centers (June-September 2025), stratifying patients into three groups: group 1 (ultra-mini: 6.3 Fr scope/<10 Fr FANS, N.=203, 23.5%), group 2 (mini: 7.5-8 Fr scope/10-12 Fr FANS, N.=446, 51.7%), and group 3 (Standard: >8 Fr scope/11-13 or 12-14 Fr FANS, N.=213, 24.7%). Stone-free rate (SFR) was classified on 30-day CT as grade A (zero residual fragment, ZRF), grade B (single RF≤2mm), grade C (single RF 2.1-4mm), grade D (single/multiple RF>4mm). Results: Age, gender, Body Mass Index, comorbidities and stone volume were similar across all groups. Overall complications occurred in 21.6% of group 3, 5.8% in group 2, and 10.8% in group 1 (P<0.001). Ureteric injury was more frequent in group 3 (15.5%) than groups 1 (2.5%) and 2 (2.2%, P<0.001). On multivariable analysis, group 3 had significantly lower odds of ZRF (OR 0.38, 95% CI 0.23-0.62, P<0.001) compared to group 1. Grades A+B SFR was 86.3%, with ZRF achieved in 76.5% overall. Group 2 demonstrated superior ZRF rates (80.5%) compared to group 1 (77.8%) and group 3 (65.4%, P<0.001). Grade D was significantly higher in group 3 (14.8%) versus group 2 (5.9%) and group 1 (4.4%). Conclusions: Ultra-mini and mini-FANS demonstrate superior safety profiles and SFRs compared to standard FANS, with mini-FANS achieving optimal outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
