World J Urol. 2025 Aug 12;43(1):486. doi: 10.1007/s00345-025-05863-3.
ABSTRACT
OBJECTIVES: To compare the efficacy and safety of flexible and navigable suction sheath (FANS) versus non-flexible suctioning ureteral access sheath (S-UAS) in retrograde intrarenal surgery (RIRS) for renal stones, using a propensity score-matched retrospective cohort analysis.
MATERIALS AND METHODS: This retrospective cohort study included 256 patients undergoing RIRS for renal stones (1-4 cm) between December 2019 and March 2025 at The First People’s Hospital of Guangyuan. Patients were divided into two groups: 199 received FANS and 57 received S-UAS. Baseline characteristics were balanced using propensity score matching (PSM) with a caliper value of 0.1. Efficacy was assessed by stone-free rate, and safety was evaluated by postoperative complications, including fever and systemic inflammatory response syndrome (SIRS). Statistical analyses were performed using R v.3.6.1, with significance set at P < 0.05.
RESULTS: Before PSM, significant baseline differences existed in age, stone diameter, CT value, lower calyceal stone prevalence, and preoperative ureteral stent insertion. After PSM, 44 matched pairs showed no significant baseline differences (all standardized mean differences < 0.1). The FANS group had a significantly lower rate of failed stone clearance (9.1% vs. 34.1%, P = 0.010) post-PSM. No significant differences were observed in operative time (70.39 ± 43.73 vs. 62.50 ± 19.54 min, P = 0.278), hospital stay (7.75 ± 4.50 vs. 7.05 ± 2.17 days, P = 0.352), or SIRS (2.3% vs. 0%, P = 1.000). Postoperative fever was not significantly different post-PSM (0% vs. 6.8%, P = 0.240).
CONCLUSION: FANS is associated with a significantly higher stone-free rate compared to S-UAS in RIRS for renal stones, with comparable safety outcomes. These findings support the use of FANS to enhance stone clearance, though prospective, multi-center trials are needed to confirm these results.
PMID:40794291 | DOI:10.1007/s00345-025-05863-3
