Lasing strategy and its influence on 30-day operative outcomes in flexible ureteroscopy with FANS: inferences from a real-world prospective multicenter study by EAU-endourology and AUSET

Gauhar V 1 , Giulioni C 2 , Falsetti F 3 , Cafarelli A 4 , Yuen SK 5 , Fong KY 6 Show all authors , Tan K 7 , Kwok JL 8 , Taguchi K 9 , Gökce MI 10 , Kamal W 11 , Gadzhiev N 12 , Malkhasyan V 13 , Hamri SB 14 , Rico L 15 , Contreras P 15 , Tan YQ 1 , Petkova K 16 , Elshazly M 17 , Tanidir Y 18 , Chai CA 19 , Tursunkulov AN 20 , Shrestha A 21 , Soebhali B 22 , El Hajj A 23 , Lakmichi MA 24 , Tefik T 25 , Persaud S 26 , Singh A 27 , Traxer O 5 , Somani B 5 , Castellani D 5

Affiliations 

  • 1 Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
  • 2 Urology Unit, Villa Igea Private Hospital, Casa di Cura Villa Igea, Ancona, 60127, Italy. carlo.giulioni9@gmail.com
  • 3 Department of Precision and Regenerative Medicine and Ionian Area- Urology, Division of Urology, Andrology and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
  • 4 Urology Unit, Villa Igea Private Hospital, Casa di Cura Villa Igea, Ancona, 60127, Italy
  • 5 Endourology Section of the European Association of Urology, Arnhem, The Netherlands
  • 6 Department of Urology, Sengkang General Hospital, Singapore, Singapore
  • 7 Department of Urology, Veterans Memorial Medical Center, Quezon City, Philippines
  • 8 Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
  • 9 Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • 10 Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  • 11 Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia
  • 12 Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
  • 13 Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
  • 14 Urology Department, Specialized Medical Center, Riyadh, Saudi Arabia
  • 15 Department of Urology, Hospital Alemán, Buenos Aires, Argentina
  • 16 Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
  • 17 Urology Department, Menoufia University, Shibin el Kom, Egypt
  • 18 Department of Urology, Medicana Atasehir Hospital, Istanbul, Turkey
  • 19 Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
  • 20 Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan
  • 21 Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • 22 Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
  • 23 Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
  • 24 Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
  • 25 Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 26 Division of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
  • 27 Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
World J Urol, 2025 Oct 28;43(1):633.
PMID: 41148343 DOI: 10.1007/s00345-025-06012-6

Abstract

PURPOSE: To compare operative and 30-day outcomes of dusting versus popcorning lithotripsy during flexible ureteroscopy (FURS) with flexible suction ureteral access sheaths (FANS) in a real-world multicenter study.

METHODS: This prospective analysis included 704 adults from 21 centers undergoing FURS for kidney stone with FANS between August 2023 and August 2024. Patients were stratified by lasing strategy into dusting (n = 281) or popcorning (n = 423). Operative parameters, complications, and stone-free status (SFS) at 30 days-assessed by 2 mm slice non-contrast CT scan were compared. Multivariable logistic regression identified predictors of complete clearance (no fragment).

RESULTS: Patients in the popcorning group presented with larger and denser stones (> 2 cm: 20.7% vs. 10.7%, p = 0.007; median HU 1100 vs. 1051, p = 0.003). Operative times were consistently longer with popcorning, including lasing (17 vs. 14 min), ureteroscopy (34 vs. 30 min), and overall duration (50 vs. 44 min, all p 

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

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