Candela Luigi, Gauhar Vineet, Somani Bhaskar, Fong Khi Y, Persaud Satyndrea, Castellani Daniele, Gadzhiev Nariman, Malkhasyan Vigen, Chai Chu A, Soebhali Boyke, Elshazly Mohammed, Tanidir Yiloren, Tan Karl M, Bin Hamri Saeed, Yuen Steffi, Tefik Tzevat, Traxer Olivier
Service of Urology, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France -
GRC n°20, Clinical Research Group on Urinary Lithiasis, Tenon Hospital, Sorbonne University, Paris, France -
Minerva Urol Nephrol. 2025 Jun;77(3):356-364. doi: 10.23736/S2724-6051.25.06274-3. Epub 2025 Apr 15.
Flexible and navigable suction ureteral access sheaths (FANS) have proven to be effective in reducing operative time and infectious complications and in increasing stone-free rate during retrograde intrarenal surgery (RIRS). FANS may reduce intrarenal pressure, thus reducing parenchymal renal damage. The aim of the present study was to assess acute kidney injury (AKI) rate following RIRS with FANS.
This was a prospective multicenter study. Patients were enrolled between August 2023 and March 2024. Inclusion criteria were: patients aged ≥18 years with normal urinary anatomy who successfully underwent RIRS using FANS for renal stones. Complete baseline and perioperative data were collected. AKI was assessed at postoperative day 1 or 2 according to the KDIGO criteria. Intra and early postoperative complications, readmissions, and reinterventions up to 30 days post-surgery were documented. Univariable logistic regression (UVA) analysis was performed to identify predictors of AKI.
Two hundred an ten patients were eligible for analysis. The median stone volume was 1320 mm. Median preoperative serum creatinine and eGFR were 0.94 mg/dL and 84 mL/min, respectively. The commonest FANS size used was 11-13 Ch (47%). A disposable scope was used in 55%, and TFL in 53% of surgeries. Median total laser time, ureteroscopy time, and operative times were 16.5, 31, and 49 minutes, respectively. At the end of the surgery, a double-J ureteral stent was placed in 84% of patients. AKI occurred in 13 (6.2%) patients. All cases were stage 1 AKI. At UVA, none of the preoperative or intraoperative variables were statistically associated with the occurrence of AKI (all P>0.05).
AKI following RIRS with FANS is a not neglectable event and endourologist should be aware of this eventuality. However, all AKI episodes were mild. This study findings should be validated with a randomized controlled trial comparing outcomes of RIRS with and without FANS.
可弯曲且可操控的输尿管吸引鞘（FANS）已被证明在逆行性肾内手术（RIRS）中可有效缩短手术时间、减少感染并发症并提高结石清除率。FANS可能会降低肾内压力，从而减少肾实质损伤。本研究的目的是评估使用FANS进行RIRS后的急性肾损伤（AKI）发生率。
这是一项前瞻性多中心研究。患者于2023年8月至2024年3月入组。纳入标准为：年龄≥18岁、尿路解剖结构正常且成功使用FANS进行肾结石RIRS的患者。收集完整的基线和围手术期数据。根据KDIGO标准在术后第1天或第2天评估AKI。记录术后30天内的术中及早期并发症、再次入院情况和再次干预情况。进行单变量逻辑回归（UVA）分析以确定AKI的预测因素。
210例患者符合分析条件。结石体积中位数为1320立方毫米。术前血清肌酐和估算肾小球滤过率（eGFR）中位数分别为0.94毫克/分升和84毫升/分钟。最常用的FANS尺寸为11 - 13 Ch（47%）。55%的手术使用了一次性输尿管镜，53%的手术使用了钬激光光纤（TFL）。激光总时间、输尿管镜检查时间和手术时间中位数分别为16.5分钟、31分钟和49分钟。手术结束时，84%的患者放置了双J输尿管支架。13例（6.2%）患者发生AKI。所有病例均为1期AKI。在UVA分析中，术前或术中变量均与AKI的发生无统计学关联（所有P>0.05）。
使用FANS进行RIRS后的AKI是一个不可忽视的事件，泌尿外科医生应意识到这种可能性。然而，所有AKI发作均为轻度。本研究结果应通过比较使用和不使用FANS的RIRS结果的随机对照试验进行验证。
