To assess the 30-day stone-free rate and peri-operative outcomes of flexible ureteroscopy (FURS) with flexible and navigable suction ureteral access sheaths (FANS) in adults undergoing same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS).
Prospectively data of 115 adult patients with bilateral kidney stone disease undergoing SSB-RIRS across 14 global centers between July 2023 and March 2024 were analyzed. Patient demographics, stone characteristics and operative outcomes were recorded. A low-dose non contrast CT scan was performed at 30 days to assess the stone-free rate and clinical outcomes.
Overall bilateral zero residual fragment(ZRF) was 42.6%; unilateral ZRF was 75.7%. Only two patients were noted to have residual fragments > 4 mm. 1.7% experienced Traxer-Thomas grade 1 ureteric injury which was managed with a ureteral stent for four weeks. No pelvicalyceal injury occured. Postoperative mean loin pain score was 1.7 ± 1.0. None had sepsis nor required blood transfusion. 4.3% required readmission within 30 days of surgery. Multivariate analysis indicated longer total operation time correlated with lower odds of achieving a 100% bilateral stone-free (ZRF) (OR 0.978, 95%CI = 0.959-0.994, p = 0.013).
To our knowledge, this is the first multicenter study demonstrating the use of FANS in SSB-RIRS can achieve bilateral ZRF with low complication and re-intervention rates. However, prolonged surgical time may negatively impact outcomes. The indications of bilateral renal stones management with FURS can be expanded in appropriate chosen patients.
World journal of urology. 2025 Feb 28*** epublish ***
Vineet Gauhar, Bhaskar Somani, Daniele Castellani, Khi Yung Fong, Nariman Gadzhiev, Satyendra Persaud, Saeed Bin Hamri, Chu Ann Chai, Azimdjon Tursunkulov, Yiloren Tanidir, Boyke Soebhali, Anil Shrestha, Deepak Ragoori, Mohamed Elshazly, Mehmet Ilker Gokce, Vigen Malkhasyan, Yasser Farahat, Thomas Herrmann, Olivier Traxer, Steffi Kar Kei Yuen
Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation., Division of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago., 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, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia., Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal., Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India., Urology Unit, Menoufia University, Shibin el Kom, Egypt., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Endourological Department, A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation., Endo-Urology & Minimally Invasive Surgery, Sheikh Khalifa Hospital, Dubai, UAE., Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, Frauenfeld, CH 8501, Switzerland., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France., S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong, China. .