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Objective <p>This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).</p> Methods <p>A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, <i>n</i> = 263) and those with reusable fURS (Group 2, <i>n</i> = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with <i>p</i> &lt; 0.05 considered significant.<!--Query ID="Q1" Text="Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct." Resolved="yes"--></p> Results <p>After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD &lt; 0.1). Group 1 was associated with shorter laser (<i>p</i> = 0.001) and operative times (<i>p</i> = 0.048), and more frequent use of larger sheaths (<i>p</i> &lt; 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, <i>p</i> = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups.&#xa0;On multivariate analysis, single-use scope use (OR 1.659, <i>p</i> = 0.018) and 10–12 Fr UAS (OR 1.749, <i>p</i> = 0.043) were significantly associated with complete stone clearance.<!--Query ID="Q2" Text="Please confirm the inserted city name is correct and amend if necessary." Resolved="yes"--></p> Conclusion <p>Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.</p>

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Single-use versus reusable flexible ureterorenoscopes with FANS: a multicenter propensity-matched analysis of outcomes in a large series from the EAU-Endourology Section and FANS Collaborative Group

  • 期刊论文

  • 发表日期：

    2025年6月26日

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  • Carlo Giulioni,
  • Daniele Castellani,
  • Federico Falsetti,
  • Naeem Bhojani,
  • Ben Hall Chew,
  • Steffi Kar Kei Yuen,
  • Anil Shrestha,
  • Pablo Contreras,
  • Sundaram Palaniappan,
  • Tsung Wen Chong,
  • Angelo Cafarelli,
  • Wei Zhu,
  • Guohua Zeng,
  • Yi Tan Quan,
  • Jia-Lun Kwok,
  • Khi Yung Fong,
  • Amelia Pietropaolo,
  • Thomas Herrmann,
  • Olivier Traxer,
  • Bhaskar Kumar Somani,
  • Vineet Gauhar

摘要

Objective

This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).

Methods

A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, n = 263) and those with reusable fURS (Group 2, n = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with p < 0.05 considered significant.

Results

After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD < 0.1). Group 1 was associated with shorter laser (p = 0.001) and operative times (p = 0.048), and more frequent use of larger sheaths (p < 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, p = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups. On multivariate analysis, single-use scope use (OR 1.659, p = 0.018) and 10–12 Fr UAS (OR 1.749, p = 0.043) were significantly associated with complete stone clearance.

Conclusion

Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.