Cacciatore Loris, Minore Antonio, Bonanno Lilla, Contessa Pierangelo, Esperto Francesco, Iannello Antonio Rosario, Papalia Rocco
Department of Urology, Fondazione Campus Bio-Medico of Rome, Rome, Italy.
Department of Urology, IRCCS Centro Neurolesi, Piemonte Hospital, Bonino Pulejo, Messina, Italy.
World J Urol. 2025 Mar 6;43(1):153. doi: 10.1007/s00345-025-05520-9.
The flexible and navigable suction ureteral access sheath (FANS) with continuous flow lithotripsy may improve stone-free rates (SFR) in ureterorenolithotripsy procedures, reducing operative time and the need for fragment extraction. This study aimed to compare the safety and efficacy of FANS versus conventional sheaths in patients undergoing retrograde intrarenal surgery (RIRS) for renal stones.
From January to September 2024, patients undergoing RIRS with high-power pulsed lasers (60 W Ho:YAG or 100 W pTm:YAG) were randomized to receive either a conventional sheath (Group 1) or FANS (Group 2). Data on baseline characteristics, operative details, and complications were collected. SFR, defined as the absence of fragments > 3 mm, was assessed with non-contrast CT scans one-month post-surgery. Statistical significance was set at p < 0.05.
A total of 132 patients were enrolled (70 with conventional sheath, 62 with FANS). The FANS group had shorter operative times (55.25 vs. 61.36 min, p = 0.028), while laser time was similar between groups. Postoperative complications were lower in the FANS group. At one month, the FANS group had a higher SFR (95% vs. 67%, p < 0.005) and fewer re-interventions (p = 0.02).
FANS significantly improves SFR without increasing postoperative complications postoperative complications or negatively affecting recovery, offering a promising alternative to conventional sheaths in ureterorenolithotripsy procedures. FANS improves kidney stone surgery outcomes, providing better stone removal, fewer complications, and faster recovery compared to the standard tool.
具有连续冲洗功能的可弯曲、可导航的输尿管鞘（FANS）与连续流碎石术相结合，可能会提高输尿管肾镜碎石术的结石清除率（SFR），减少手术时间以及碎片取出的需求。本研究旨在比较FANS与传统鞘在接受逆行性肾内手术（RIRS）治疗肾结石患者中的安全性和有效性。
2024年1月至9月，接受高功率脉冲激光（60W钬激光或100W倍频Nd:YAG激光）RIRS的患者被随机分为接受传统鞘组（第1组）或FANS组（第2组）。收集基线特征、手术细节和并发症的数据。结石清除率定义为术后1个月非增强CT扫描显示无>3mm的碎片，以此评估结石清除率。设定统计学显著性为p<0.05。
共纳入132例患者（70例使用传统鞘，62例使用FANS）。FANS组手术时间较短（55.25分钟对61.36分钟，p=0.028），而两组激光照射时间相似。FANS组术后并发症较少。术后1个月，FANS组结石清除率更高（95%对67%，p<0.005），再次干预更少（p=0.02）。
FANS显著提高结石清除率，且不增加术后并发症或对恢复产生负面影响，在输尿管肾镜碎石术中是传统鞘的一个有前景的替代方案。与标准工具相比，FANS改善了肾结石手术的结果，结石清除效果更好，并发症更少，恢复更快。
