To compare the two suction technologies, namely suction mini-percutaneous nephrolithotomy (SM-PCNL) and flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) for renal stone management.
Propensity-matched pair analysis was conducted on prospectively collected data from two global registries. The Suction mini-PCNL registry (STUMPS) included 30 centers across 21 countries, and the Flexible and Navigable Suction Access Sheath in Ureteroscopy registry (FANS) involved 25 centers across 20 countries. Each group included 686 patients after matching for age, sex, Guy's stone score, and stone volume. The primary outcome was the stone-free rate (SFR), assessed by 30-day non-contrast CT scan, categorized as Grade A (100% clearance or zero residual fragment, ZRF), Grade B (single ≤ 4 mm residual fragment), or Grade C (any fragment > 4 mm or multiple fragments).
In the matched cohort, immediate ZRF was significantly higher in SM-PCNL (85.7% vs. 60.1%, p < 0.001), and reinterventions were fewer (0.9% vs. 4.4%, p < 0.001). FANS demonstrated significantly superior recovery profiles with lower postoperative pain scores (VAS 1.0 vs. 2.0, p < 0.001), shorter hospital stays (1.0 vs. 2.0 days, p < 0.001), and reduced need for basket extraction (9.5% vs. 24.5%, p < 0.001). Operative time difference of 6 min, favoring SM-PCNL was noted (46 vs. 40 min, p < 0.001). Complication rates were low and comparable: fever managed by observation (2.1% FANS vs. 3.2% SM-PCNL, p = 0.29) or antibiotics (3.1% FANS vs. 6.0% SM-PCNL, p = 0.08), blood transfusion (0.1% FANS vs. 0.3% SM-PCNL, p > 0.99). No sepsis case was reported for both modalities. Multivariable analysis identified SM-PCNL as a significant independent predictor of Grade A stone-free status (OR 4.06, 95% CI 3.06-5.43, p < 0.001). Notably higher stone complexity GSS 2 and 3 had significantly better predictive odds of lower SFR than stone volume. Stone volume was a predictor of any complications (OR 1.16, 95% CI 1.03-1.30, p = 0.01).
Both techniques are safe and effective; SM-PCNL is better for achieving 100% stone clearance, especially in GSS 2 and 3 cases. FANS offers faster recovery and lower postoperative pain scores. The Guy's stone score is useful to predict 100% SFR for both modalities. Even though the proposed re-intervention rate was higher in FANS, as ours is only a 30-day follow-up study, the true reintervention rate and outcomes are lacking.
World journal of urology. 2025 Oct 29*** epublish ***
Angelo Cormio, Daniele Castellani, Steffi Kar-Kei Yuen, Khi Yung Fong, Nariman Gadzhiev, Jaisukh Kalathia, Amish Mehta, Vigen Malkhasyan, Nitesh Kumar, Edgar Beltrán-Suárez, Abhay Mahajan, Karl Tan, Kremena Petkova, Kazumi Taguchi, Mohamed Amine Lakmichi, Yiloren Tanidir, Marcos Cepeda, Alexey Martov, Zelimkhan Tokhtiyev, Lazaros Tzelves, Andreas Skolarikos, Mahmoud Laymon, Esteban Acuña, Wissam Kamal, Heng Chin Tiong, Leonardo Gomes Lopes, Dmitriy Gorelov, Bhaskar K Somani, Thomas R W Herrmann, Vineet Gauhar
Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy. ., Endourology Section of the European Association of Urology, Arnhem, The Netherlands., Department of Urology, Sengkang General Hospital, Singapore, Singapore., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Fortune Urology Clinic, Botad, Gujarat, India., B T Savani kidney hospital, Rajkot, Gujarat, India., Department of Urology, Moscow Urology Center, Botkin Hospital, Moscow, Russia., Department of Urology, Ford Hospital and Research Centre, Patna, Bihar, India., Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico., Department of urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India., Department of Urology, Veterans Memorial Medical Center, Quezon City, Philippines., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Department of Urology, Faculty of Medicine, University Hospital Mohammed the VIth, Cadi Ayyad University, Marrakesh, Morocco., Department of Urology, Medicana Atasehir Hospital, Istanbul, Turkey., Department of Urology and Andrology, IPPE of A.I. Burnazyan SSC FMBC, FMBA of Russia, Moscow, Russia., Second Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece., Department of Urology, Urology and Nephrology center, Mansoura University, Mansoura, Egypt., Department of Urology, Institution Hospital Provincial de Ovalle, Ovalle, Coquimbo, Chile., Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia., Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Hospital Orizonti and Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil., Department of Urology, First Saint-Petersburg State Medical University, Saint-Petersburg, Russia.