Introduction: Flexible ureteroscopy (FURS) using the flexible and navigable suction ureteral access sheath (FANS) is a novel technique for treatment of kidney stones. We aimed to compare outcomes of FURS with FANS in the sitting vs standing position. Patients and Methods: We analyzed adult patients from 21 centers who underwent FURS with FANS, divided according to whether the surgeon operated in a sitting or standing position. Baseline demographics, operative parameters, and 30-day outcomes were compared. Multivariable logistic regression was used to identify potential predictive factors for zero residual fragments (ZRF). Results: There were 457 patients in the sitting group and 247 patients in the standing group. In the sitting group, more patients had the surgical procedure under general anesthesia (p = 0.022). Disposable scopes were preferred in the standing group (p < 0.001). Median lasing and ureteroscopy time were significantly shorter in the siting group, but there was no difference in total surgical time (median 45 vs 46 minutes, p = 0.102). A larger but nonsignificant percentage of grade 1 access sheath insertion injuries were reported in the standing position. Multivariable logistic regression analysis showed that stone volume (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, p = 0.003) and operative time (OR: 0.99, 95% CI 0.99-1.00, p = 0.002) but not surgeon position (OR: 1.04, 95% CI: 0.75-1.44, p = 0.82) were significant predictors of ZRF. Procedural safety was not compromised significantly. Conclusions: FURS with FANS is equally safe and effective in the sitting and standing positions. This study provides the impetus to improve FURS ergonomics, especially with the move toward its use in complex and large stones.
Journal of endourology. 2025 Jul 29 [Epub ahead of print]
Khi Yung Fong, Bhaskar Somani, Patrick Juliebø-Jones, Daniele Castellani, Chin Tiong Heng, Jia-Lun Kwok, Chu-Ann Chai, Wissam Kamal, Chinnakhet Ketsuwan, Kremena Petkova, Boyke Soebhali, Marek Zawadzki, Saeed Bin Hamri, Mohamed Elshazly, Yi Quan Tan, Pablo Nicolas Contreras, Lazaros Tzelves, Andreas Skolarikos, Steffi Yuen, Olivier Traxer, Vineet Gauhar
Department of Urology, Singapore General Hospital, Singapore, Singapore., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom., Department of Urology, Haukeland University Hospital, Bergen, Norway., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore., Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia., Department of Urology And Endourology, King Fahd General Hospital Jeddah, Jeddah, Saudi Arabia., Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia., Department of Urology, St. Anna Hospital, Piaseczno, Poland., Urology Department, Specialized Medical Center (SMC), Riyadh, Saudi Arabia., Urology Unit, Menoufia University, Shibin El Kom, Egypt., Department of Urology, Hospital Alemán, Buenos Aires, Argentina., Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece., SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Sorbonne University, AP-HP, Hôpital Tenon, Paris, France.