Assessment of Outcomes & Anatomical Changes in the Upper Urinary Tract following Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath (FANS): 3-Month Results from a Multicenter Study

Fong KY 1 , Yuen SKK 2 , Somani BK 3 , Malkhasyan V 4 , Tanidir Y 5 , Persaud S 6 Show all authors , El Hajj A 7 , Chai CA 8 , Tefik T 9 , Tan K 10 , Elshazly M 11 , Ragoori D 12 , Gokce MI 13 , Soebhali B 14 , Bin Hamri S 15 , Gadzhiev N 16 , Turney B 17 , Traxer O 18 , Castellani D 19 , Gauhar V 20

Affiliations 

  • 1 Department of Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 2 SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
  • 3 Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
  • 4 Moscow Urology Center, Botkin Hospital, Moscow, Russia
  • 5 Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
  • 6 Division of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
  • 7 Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
  • 8 Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
  • 9 Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
  • 10 Department of Surgery, Section of Urology, Veterans Memorial Medical Center, Quezon City, Philippines
  • 11 Urology Unit, Menoufia University, Shibin el Kom, Egypt
  • 12 Department of Urology, Asian Institute of Nephrology & Urology, Hyderabad, India
  • 13 Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  • 14 Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
  • 15 Urology Department, Specialized Medical Center (SMC), Riyadh, Saudi Arabia
  • 16 Department of Urology, St. Petersburg State University Hospital, St. Petersburg, Russia
  • 17 Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  • 18 Department of Urology, Sorbonne University, AP-HP, Hôpital Tenon, Paris, France
  • 19 Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
  • 20 Department of Urology, Ng Teng Fong General Hospital, Singapore
Urology, 2025 Jan 16.
PMID: 39826806 DOI: 10.1016/j.urology.2025.01.029

Abstract

OBJECTIVES: To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated.

METHODS: This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. 30-day postoperative stone free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications.

RESULTS: 310 patients were analyzed. Median age was 51; median stone volume was 1584 mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14min, median ureteroscopy time was 30min, and median total operation time was 45min. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. 30-day reintervention rate was 4.2% (13 cases). 3-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded.

CONCLUSIONS: The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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