Comparison of flexible and navigable suction ureteral access sheath with conventional ureteral access sheath for pediatric retrograde intrarenal surgery: a single-center propensity-matched analysis.

Abstract

The flexible and navigable suction ureteral access sheath (FANS-UAS) has increasingly been recognized as a potential game changer for retrograde intrarenal surgery (RIRS). While this innovative technology has demonstrated promising results in adult populations, there is a notable lack of evidence regarding its application in pediatric cases, particularly in comparison to conventional ureteral access sheaths (CUAS). This study aimed to perform a comparative analysis of pediatric kidney stone cases treated with RIRS using FANS-UAS and CUAS. We conducted a retrospective matched pair analysis, matching patients based on preoperative age, stone location, and stone size. After matching, data from 46 patients (23 in each group) were analyzed. The groups were comparable in terms of age, hydronephrosis degree, location and size of the stone (p = 0.543, p = 0.807, p = 0.840, and p = 0.577, respectively). Operation times were shorter in the FANS-UAS group (CUAS: 67.9 ± 21.0 min, FANS-UAS: 50.4 ± 21.1 min, p = 0.007). The initial stone-free rate (SFR) was 65.2% in the CUAS group and 91.3% in the FANS-UAS group, with a statistically significant difference (p = 0.032). However, no significant difference was found regarding the final SFR (p = 0.295). The number and duration of DJ-stents, were significantly higher in the CUAS group (p = 0.006 for both). The FANS-UAS group had a significantly fewer anesthesia sessions (p = 0.001). There were no significant differences in complication rates (p = 0.303). Our findings suggest that FANS-UAS offers significant advantages over CUAS in pediatric RIRS, including higher initial success rates, shorter operation times, reduced anesthesia requirements, and fewer treatment sessions, with comparable safety profiles.