Does intraoperative surgeon reported stone free status (IO-SFS) correlate with CT based post operative stone free status (PO-SFS) in flexible ureteroscopy using flexible and navigable suction ureteral access sheath (FANS) in real-world practice? A prospective global FANS collaborative study group initiative with the section of EAU endourology

Gauhar V 1 , Traxer O 2 , Yuen SKK 3 , Castellani D 4 , Zeng G 5 , Fong KY 6 Show all authors , Wei Z 5 , Ragoori DR 7 , Elshazly M 8 , Petkova K 9 , Kamal W 10 , Gadzhiev N 11 , Gokce MI 12 , Lakmichi MA 13 , Lee C 6 , El Hajj A 14 , Zawadzki M 15 , Rico L 16 , Contreras P 16 , Tefik T 17 , Chai CA 18 , Geavlete P 19 , Sarica K 20 , Kwok JL 21 , Somani BK 22 , Lim EJ 23

Affiliations 

  • 1 Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
  • 2 Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
  • 3 SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
  • 4 Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
  • 5 Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
  • 6 Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
  • 7 Asian Institute of Nephrology and Urology, Urology, 6-3-562/A, Errum Manzil, Hyperabad, 500082, Telangana, India
  • 8 Faculty of Medicine Urology Department, Menoufia university, Shibin el Kom, Egypt
  • 9 Department of Urology and Nephrology, Military Medical Academy, 3, Georgi Sofiiski blvd., Sofia, 1606, Bulgaria
  • 10 Division of Urology, Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
  • 11 Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
  • 12 Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  • 13 Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
  • 14 Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
  • 15 Urology Unit, St. Anna Hospital, Piaseczno, Poland
  • 16 Department of Urology, Hospital Aleman, Buenos Aires, Argentina
  • 17 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 18 Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
  • 19 Saint John Emergency Clinical Hospital, Bucharest, Romania
  • 20 Department of Urology, Medical School, Biruni University, Istanbul, Turkey
  • 21 Department of Urology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
  • 22 University Hospital Southampton NHS Foundation Trust GB, Southampton, UK
  • 23 Department of Urology, Singapore General Hospital, Academia Level 5, 20 College Rd, Singapore, 169856, Singapore. eejeanlim@gmail.com
World J Urol, 2025 Mar 21;43(1):184.
PMID: 40119185 DOI: 10.1007/s00345-025-05570-z

Abstract

BACKGROUND: Flexible and navigable suction ureteral access sheath (FANS) has been proven to improve stone-free rate (SFR) and many studies report high intraoperative 100% stone-free status (IO-SFS) and postoperative 100% stone-free status (PO-SFS). The reliability of IO-SFS vis-à-vis image-proven PO-SFS needs to be evaluated as it has implications on perioperative management.

METHODS: Our prospective, multicenter study enrolled 704 adult patients from 21 centers who underwent FURS with FANS between August 2023 and October 2024. IO-SFS was categorized into three groups: (1) 100% SFR (no dust or fragments), (2) only dust remaining, and (3) both dust and fragments remaining. PO-SFS was assessed via 2 mm non-contrast computed tomography (NCCT) at 30 days and categorized into four grades: Grade A (100% stone-free), Grade B (single ≤ 2 mm residual fragment), Grade C (single 2.1-4 mm), and Grade D (multiple or any > 4 mm). Primary outcome was correlation between intraoperative and postoperative 100% SFS. Secondary outcomes included perioperative complications, reintervention rates, and predictors of residual fragments and perioperative complications.

RESULTS: IO-SFS reported 100% SFR in 395 cases. Postoperative NCCT confirmed a significantly higher SFS (Grade A + B) in this group (99%) compared to 95.8% in the dust only group and 61.1% in the dust and fragments group (p 

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