Use of suction in flexible ureteroscopy is increasing lately. The introduction of flexible and navigable suction access sheath (FANS) has shown improved stone free rate (SFR). However, its efficacy in lower pole stone (LPS) in terms of SFR and complications is yet to be studied.
We collected data from 25 centers that included 394 adult patients undergoing ureteroscopy using FANS. Non contrast CT (NCCT) scan was done within first 30 days post operatively to access the SFR. Residual fragments were graded as A: 100% SFR; B: single fragment ≤ 2 mm; C: single fragment 2.1-4 mm; D: Single or multiple fragments > 4 mm. Post operative complications were recorded.
Out of 394 patients, non LPS (group1) comprised of 268 patients, rest 126 patients had LPS (group 2). Single stage zero fragment SFR was seen in 58.6% (group 1) vs. 54.8% (group 2) (P = 0.619). Single stage grade A + B SFR was achieved in 96.6% vs. 98.4% in groups 1 and 2 respectively. On multivariate analysis Thulium fiber laser use was significantly associated with higher odds of being grade A stone-free, while stone volume with lower odds. In LPS group only two patients needed reintervention. The highest grade of complication was Clavien 2, which was seen in 3.2% LPS group.
Use of flexible and navigable suction ureteric access sheath for lower pole stones is effective and safe. The stone free rate of lower pole stones is comparable to non-lower pole locations with very low reintervention rate in both groups.
World journal of urology. 2024 Dec 20*** epublish ***
Anil Shrestha, Olivier Traxer, Christian Seitz, Mariela Corrales, Daniele Castellani, Ben Hall Chew, Deepak Ragoori, Udita Mishra, Saeed Bin Hamri, Karl Marvin Tan, Steffi Kar Kei Yuen, Akash Chitrakar, Etienne Xavier Keller, Bhaskar Kumar Somani, Vineet Gauhar
Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal. ., Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France., Department of Urology, Medical University of Vienna, Vienna, Austria., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Department of Urology, University of British Columbia Vancouver, Vancouver, Canada., Department of Urology, Asian Institute of Nephrology & Urology Hyderabad, Hyderabad, India., Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal., Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Department of Surgery, Section of Urology, Veterans Memorial Medical Center, Quezon City, Philippines., SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, University Hospitals Southampton, NHS Trust Southampton, UK.