Minerva urology and nephrology · 2026
A prospective multicenter study of Flexible ureteroscopy using different flexible and navigable suction access sheath (FANS) sizes: peri and 30-day postoperative outcomes from the global and prospective multicenter FLEXible ureteroscopy Outcomes Registry using FANS (FLEXOR-F) by the EAU section of endourology.
СтатьяНазвание и аннотация: Перевод в очереди
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Gauhar Vineet, Yuen Steffi K, Somani Bhaskar K, Angerri Oriol, Demirkiran Denizhan, Fong Khi Y, Petkova Kremena, Soebhali Bokye, Parikesit Dyandra, Sissoko Idrissa, Rico Luis, Tzelves Lazaros, Mazzon Giorgio, Tsaturyan Arman, Elshazly Mohamed, Politi Estaban, Sytnik Dmitry, Tefik Tzevat, Jingzeng Du, Chong Tsung W, Sen Volkan, Aydin Cemil, Akdogan Nebil, Tanidir Yiloren, Geavlete Petrisor, Traxer Olivier, Ferretti Stefania, Castellani Daniele
Аннотация
BACKGROUND: Flexible and Navigable Suction Ureteral Access Sheath (FANS) revolutionized flexible ureteroscopy for stone management. This study assessed outcomes using a standardized FANS classification across different ureteroscope-sheath combinations.
METHODS: We prospectively enrolled 862 adult patients from 21 centers (June-September 2025), stratifying patients into three groups: group 1 (ultra-mini: 6.3 Fr scope/<10 Fr FANS, N.=203, 23.5%), group 2 (mini: 7.5-8 Fr scope/10-12 Fr FANS, N.=446, 51.7%), and group 3 (Standard: >8 Fr scope/11-13 or 12-14 Fr FANS, N.=213, 24.7%). Stone-free rate (SFR) was classified on 30-day CT as grade A (zero residual fragment, ZRF), grade B (single RF≤2mm), grade C (single RF 2.1-4mm), grade D (single/multiple RF>4mm).
RESULTS: Age, gender, Body Mass Index, comorbidities and stone volume were similar across all groups. Overall complications occurred in 21.6% of group 3, 5.8% in group 2, and 10.8% in group 1 (P<0.001). Ureteric injury was more frequent in group 3 (15.5%) than groups 1 (2.5%) and 2 (2.2%, P<0.001). On multivariable analysis, group 3 had significantly lower odds of ZRF (OR 0.38, 95% CI 0.23-0.62, P<0.001) compared to group 1. Grades A+B SFR was 86.3%, with ZRF achieved in 76.5% overall. Group 2 demonstrated superior ZRF rates (80.5%) compared to group 1 (77.8%) and group 3 (65.4%, P<0.001). Grade D was significantly higher in group 3 (14.8%) versus group 2 (5.9%) and group 1 (4.4%).
CONCLUSIONS: Ultra-mini and mini-FANS demonstrate superior safety profiles and SFRs compared to standard FANS, with mini-FANS achieving optimal outcomes.
METHODS: We prospectively enrolled 862 adult patients from 21 centers (June-September 2025), stratifying patients into three groups: group 1 (ultra-mini: 6.3 Fr scope/<10 Fr FANS, N.=203, 23.5%), group 2 (mini: 7.5-8 Fr scope/10-12 Fr FANS, N.=446, 51.7%), and group 3 (Standard: >8 Fr scope/11-13 or 12-14 Fr FANS, N.=213, 24.7%). Stone-free rate (SFR) was classified on 30-day CT as grade A (zero residual fragment, ZRF), grade B (single RF≤2mm), grade C (single RF 2.1-4mm), grade D (single/multiple RF>4mm).
RESULTS: Age, gender, Body Mass Index, comorbidities and stone volume were similar across all groups. Overall complications occurred in 21.6% of group 3, 5.8% in group 2, and 10.8% in group 1 (P<0.001). Ureteric injury was more frequent in group 3 (15.5%) than groups 1 (2.5%) and 2 (2.2%, P<0.001). On multivariable analysis, group 3 had significantly lower odds of ZRF (OR 0.38, 95% CI 0.23-0.62, P<0.001) compared to group 1. Grades A+B SFR was 86.3%, with ZRF achieved in 76.5% overall. Group 2 demonstrated superior ZRF rates (80.5%) compared to group 1 (77.8%) and group 3 (65.4%, P<0.001). Grade D was significantly higher in group 3 (14.8%) versus group 2 (5.9%) and group 1 (4.4%).
CONCLUSIONS: Ultra-mini and mini-FANS demonstrate superior safety profiles and SFRs compared to standard FANS, with mini-FANS achieving optimal outcomes.