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Multicenter Study
. 2024 Nov 15;52(1):162.
doi: 10.1007/s00240-024-01662-4.

Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

Jia-Lun Kwok  1   2 , Bhaskar Somani  3 , Kemal Sarica  4   5 , Steffi Kar Kei Yuen  6 , Marek Zawadzki  7 , Daniele Castellani  8 , Satyendra Persaud  9 , Chu Ann Chai  10 , Wissam Kamal  11 , Tzevat Tefik  12 , Azimdjon N Tursunkulov  13 , Boyke Soebhali  14 , Albert El Hajj  15 , Raymond Ko  16 , Khi Yung Fong  17 , Laurian Dragos  18 , Yiloren Tanidir  19 , Oriol Angerri  20 , Olivier Traxer  21   22 , Vineet Gauhar  21   23
Affiliations
Multicenter Study

Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

Jia-Lun Kwok et al. Urolithiasis. .

Abstract

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm3, p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.

Keywords: Flexible and navigable suction ureteral access sheaths; Flexible ureteroscopy; Lithotripsy; Sheath size; Suction.

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Conflict of interest statement

Declarations Ethics approval All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Asian Institute of Nephrology and Urology, Hyderabad (#AINU 12/2022). Consent to participate Informed consent was obtained from all individual participants included in the study. Financial disclosures The authors have no relevant financial or non-financial interests to disclose. Competing interests The authors declare no competing interests.

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