Sex Disparity in Flexible Ureteroscopic Lithotripsy with Flexible and Navigable Suction Ureteral Access Sheath for 2- to 3-cm Upper Urinary Tract Stones: Shorter Operative Time in Female Patients.
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Abstract
Introduction: The flexible and navigable suction ureteral access sheath (FANS-UAS) has expanded the indications for flexible ureteroscopic lithotripsy (fURL) to include upper urinary tract stones (UUTSs) measuring 2-3 cm. However, the impact of patient sex on surgical efficiency with this novel technique remains unknown.
Methods: This single-center retrospective study enrolled 318 consecutive patients (210 males and 108 females) who underwent fURL with FANS-UAS for a solitary UUTS measuring 2-3 cm, between December 2024 and May 2026. Exclusion criteria included anatomical abnormalities and severe organ dysfunction. Baseline parameters, operative time (total and by phase), stone-free rates (SFRs) on postoperative day (POD) 1 and POD 30, and Clavien-Dindo complications were compared between sexes. Three general linear models (GLMs) were constructed to adjust for age, stone size, hydronephrosis, and other confounders, and to dissect the effect of sex on total operative time, fragmentation time, and fragment retrieval time.
Results: Total operative time was significantly shorter in females than in males (63.4 ± 15.0 vs. 79.9 ± 21.4 min, p < 0.01), driven predominantly by a marked reduction in fragment retrieval time (36.5 ± 10.4 vs. 50.9 ± 13.5 min, p < 0.01), whereas fragmentation time did not differ significantly (17.8 ± 5.7 vs. 18.4 ± 5.9 min, p = 0.341). Immediate SFR (86.1% vs. 87.6%, p = 0.704) and follow-up SFR at POD 30 (91.7% vs. 90.0%, p = 0.831) were comparable, as were overall complication rates. GLM analysis confirmed female sex as the strongest independent predictor of shorter total operative time (B = -18.5, 95% CI: -21.6 to -15.4, F = 134.9, p < 0.01) and fragment retrieval time (B = -15.6, 95% CI: -17.8 to -13.4, F = 191.1, p < 0.01).
Conclusion: Female patients undergoing fURL with FANS-UAS for UUTSs measuring 2-3 cm have significantly shorter operative times than males. Patient sex should be considered in preoperative counseling and surgical planning.
期刊介绍：
Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.
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