This study aims to evaluate the safety, efficacy and clinical outcomes of elective flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) in patients with upper tract infectious stones following initial management of systemic urinary tract infections (UTIs).
We conducted a multicentre prospective analysis of patients with infectious ureteral or kidney stones (struvite or calcium carbonate-apatite) who underwent flexible ureteroscopy using FANS between March 2024 and March 2025. All patients had prior systemic UTI management with a minimum 6-week interval before definitive stone treatment. Stone-free rate was assessed at 30 days using a CT scan.
The cohort included 144 patients (median age 51 years, 70.1% female) with a median stone diameter of 1.9 cm. 20.1% had initially received only antibiotic treatment, whereas 79.9% had also received emergency drainage. Forty-seven patients (32.6%) had emphysematous pyelonephritis at initial presentation. Median operative time was 40 min with a 1-day hospital stay. Notable findings included zero cases of sepsis and a 29.9% rate of postoperative fever requiring extended antibiotics up to 2 weeks. Zero residual fragments were achieved in 48.6% and a single fragment up to 2 mm in 43.8% of patients (92.4% combined stone-free rate). Renal function improved at 30 days (median creatinine decrease -15 μmol/L) and 3 months (-18 μmol/L). Fever rate was 29.8% in the emphysematous pyelonephritis subgroup.
Elective flexible ureteroscopy using FANS for upper tract infectious stones is feasible for its excellent safety profile with no sepsis cases and high stone-free rates. FANS technology appears to offer significant advantages in this challenging patient population by mitigating postoperative sepsis due to debris aspiration, reduction of pyelovenous backflow of contaminated irrigation fluids and improved stone fragment evacuation.
BJUI compass. 2026 Feb 04*** epublish ***
Angelo Cormio, Daniele Castellani, Steffi Kar Kei Yuen, Khi Yung Fong, Deepak Ragoori, Laurian Dragos, Mohamed Omar, Luigi Cormio, Guohua Zeng, Wei Zhu, Shusheng Liu, Thomas R W Herrmann, Bhaskar K Somani, Chi Fai Ng, Mohamed Elshazly, Vineet Gauhar
Urology Unit Azienda Ospedaliero-Universitaria delle Marche Ancona Italy., Endourology Section of the European Association of Urology Arnhem the Netherlands., Department of Urology Sengkang General Hospital Singapore Singapore., Department of Urology, Asian Institute of Nephrology & Urology Irram Manzil Colony Hyderabad Telangana India., Urology Unit Cambridge University Hospitals NHS Foundation Trust Cambridge UK., Urology Department Menoufia University Shibin el Kom Egypt., Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia University of Foggia Foggia Italy., Department of Urology and Guangdong Key Laboratory of Urology First Affiliated Hospital of Guangzhou Medical University Guangzhou China., Department of Surgery, S.H. Ho Urology Centre The Chinese University of Hong Kong Hong Kong China.