MATERIALS AND METHODS: A customized web-based 28 items questionnaire was created. All participation was voluntary. The survey was hosted on Google Forms between 15th November 2023 and 25th November 2023. Descriptive statistics were applied to demographic details and categorical responses.
RESULTS: 632 responses were received. 56.5% were from Asia. 41.6% of respondents underwent an endourology fellowship. Personal experience of suction for PCNL was noted in 55.4% and 42.7% for RIRS. 34.9% believe that currently there is enough evidence that suction can improve stone free rates and lower complications for both endourology surgeries. 55.69% believe that as evidence evolves, suction has the potential to be a game changer in endourology management of urolithiasis. 55.7% believe that the leading barrier to the adoption of suction in endourology is the lack of availability of technology. Other barriers include lack of procedural standardization (37.65%), lack of evidence (34.9%), lack of proper training (29.58%) and lack of advocation in the current guidelines (17.72%).
CONCLUSION: Our survey shows that urologists are keen to adopt suction for PCNL and RIRS but the lack of definitive evidence, standardization, equipment availability and training preclude them from using so. More high-level evidence regarding the utility of suction in endourology is required for its routine adoption in clinical practice.
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.