The utility of flexible and navigable suction access sheath (FANS) in patients undergoing same session flexible ureteroscopy for bilateral renal calculi: a global prospective multicenter analysis by EAU endourology - Report - MDSpire
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The utility of flexible and navigable suction access sheath (FANS) in patients undergoing same session flexible ureteroscopy for bilateral renal calculi: a global prospective multicenter analysis by EAU endourology
Clinical Report: FANS in Same-Sitting Bilateral Flexible Ureteroscopy for Kidney Stones
Overview
This global prospective multicenter study evaluated the use of flexible and navigable suction access sheath (FANS) in same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for bilateral kidney stones. Among 115 patients, the overall bilateral zero residual fragment (ZRF) rate was 42.6%, with high surgeon satisfaction regarding FANS utility and low complication rates.
Background
Bilateral kidney stone disease significantly impacts quality of life and often requires multiple surgical interventions. Clinicians face a choice between single-session bilateral surgery and staged procedures, with single-session approaches offering potential cost and resource benefits. Flexible ureteroscopy with FANS has shown promise in improving stone-free rates and reducing complications. This study aimed to assess perioperative outcomes and stone-free rates following SSB-RIRS using FANS.
Data Highlights
Parameter
Value
Number of patients
115
Median operative time (min)
70
Median ureteroscopy time (min)
56
Median laser time (min)
16
Stone diameter distribution (Left side)
<1 cm: 42.6%, 1.1–2 cm: 48.7%, >2 cm: 8.7%
Stone diameter distribution (Right side)
<1 cm: 53.0%, 1.1–2 cm: 40.9%, >2 cm: 6.1%
Median stone volume (mm3)
Left: 1407, Right: 1342
Median Hounsfield units
Left: 1012, Right: 1020
Use of Thulium Fiber Laser
73%
Successful suction function
98.2%
Access to lower pole bilaterally
77%
Bilateral zero residual fragment (ZRF) rate
42.6%
Use of stone baskets
33%
Change to new ureteral access sheath
1.7%
Bilateral ureteral stents placed
75.7%
Key Findings
42.6% of patients achieved bilateral zero residual fragments (Grade A) at 30 days post-procedure.
FANS was successfully deployed bilaterally in all included patients with a suction success rate of 98.2%.
Surgeons rated FANS highly for ease of suction, maneuverability, and contribution to visualization during laser lithotripsy (Likert score average 1–2).
Access to the lower pole of both kidneys was achieved in 77% of cases, facilitating comprehensive stone clearance.
Low complication rates were observed, with only 1.7% requiring a change of ureteral access sheath.
Majority of patients (75.7%) had bilateral ureteral stents placed as an exit strategy post-procedure.
Clinical Implications
The use of FANS in same-sitting bilateral flexible ureteroscopy is feasible and safe, providing effective suction and improved maneuverability within the pelvicalyceal system. This approach can achieve satisfactory stone-free rates while minimizing the need for staged procedures, potentially reducing overall patient morbidity and healthcare costs. Surgeons can consider FANS as a valuable adjunct in managing bilateral kidney stones in a single session.
Conclusion
This multicenter study supports the clinical utility of FANS in enhancing outcomes of same-sitting bilateral flexible ureteroscopy for kidney stones, demonstrating favorable stone-free rates and perioperative safety. FANS may represent a significant advancement in the endourological management of bilateral kidney stone disease.
References
Castellani et al. 2023 -- Outcomes of Bilateral RIRS
