Flexible suction ureteral access sheaths vs. sheathless RIRS for renal and proximal ureteral stones: a comparative study.

Abstract

Purpose: This study aimed to compare the efficacy and safety of flexible and navigable suction ureteral access sheath (FANS)-assisted retrograde intrarenal surgery (RIRS) vs. sheathless techniques in treating renal/proximal ureteral stones, with a focus on immediate and short-term stone clearance rates, stenting duration, and complications.

Methods: A retrospective cohort analysis was conducted on 115 patients (FANS group: 73; control group: 42) with comparable mean stone diameters (FANS: 14.1 ± 5.4 mm vs. control: 12.2 ± 4.9 mm, P = 0.06). Outcomes assessed included immediate (postoperative day 1) and 1-month stone-free rates (SFRs), operative time, ureteral stenting duration, and complications.

Results: The FANS group demonstrated a significantly higher immediate SFR (84.9% vs. 69.0%, P < 0.05), while the 1-month SFRs were comparable (91.8% vs. 90.5%). Despite longer operative times (51 vs. 40 min, P < 0.05), the FANS group had a shorter stenting duration (12 vs. 21 days, P < 0.05). Complication rates were similar (FANS: 11.0% vs. control: 11.9%), with no ureteral injuries in either group.

Conclusions: FANS-assisted RIRS demonstrated superior immediate stone clearance compared to sheathless RIRS, which may be particularly advantageous for managing complex or infected stones, where complete initial clearance is clinically paramount. In addition, the significantly shorter stenting duration with FANS offers distinct benefits for stent-intolerant patients. While both techniques achieved similar 1-month stone-free rates, these advantages position FANS as a valuable option for selected patients based on stone characteristics and individual clinical priorities. Further studies should explore long-term outcomes and cost-effectiveness.