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Purpose <p>To evaluate the efficacy and safety of flexible ureteroscopy (FURL) combined with flexible and navigable suction ureteral access sheaths (FANS) compared to conventional FURL for treating 1–2&#xa0;cm complex lower calyceal stones.</p> Methods <p>A retrospective single-center study was conducted at the Affiliated Hospital of Shandong Second Medical University, analyzing patients treated between July 2023 and February 2025. Inclusion criteria were: (i) preoperative CT diagnosis of 1–2&#xa0;cm single lower calyceal stones; (ii) preoperative intravenous urography (IVU) identifying direct insertion of minor calyces into the renal pelvis or branched fusion forming major calyceal openings; and (iii) surgeries performed by one fellowship-trained endourologist for procedural standardization. Exclusion criteria included: (i) uncontrolled preoperative urinary tract infections; (ii) significant ureteral strictures; (iii) severe cardiopulmonary dysfunction or coagulation disorders; (iv) unforeseen postoperative events unrelated to the procedure; and (v) incomplete perioperative data. Patients were divided into an intervention group (FURL with FANS) and a control group (standard FURL with conventional ureteral access sheath). Baseline characteristics, stone-free rates, operative time, hospital stay, and postoperative complications were compared using weighted t-tests, Chi-square tests, or Fisher’s exact test.</p> Results <p>The study included 69 patients (intervention group, <i>n</i> = 36; control group, <i>n</i> = 33). After inverse probability of treatment weighting(IPTW) adjustment, baseline characteristics, including age, sex, BMI, stone size, and stone density, showed no significant differences between groups (<i>P</i> &gt; 0.05). The intervention group demonstrated a significantly higher stone-free rate (75.5% vs. 48.9%, <i>P</i> = 0.010), defined as residual fragments &lt; 4&#xa0;mm on CT at postoperative day 30, shorter operative time (63.02 ± 8.17&#xa0;min vs. 73.92 ± 15.56&#xa0;min, <i>P</i> &lt; 0.001), shorter hospital stay (3.15 ± 0.46 days vs. 5.16 ± 1.35 days, <i>P</i> &lt; 0.001), and lower incidence of postoperative fever (0% vs. 12.5%, <i>P</i> = 0.047).</p> Conclusions <p>FURL combined with FANS offers superior efficacy and safety compared to conventional FURL for managing 1–2&#xa0;cm complex lower calyceal stones. This approach resulted in higher stone-free rates, reduced operative times, shorter hospital stays, and fewer postoperative complications, presenting a promising alternative for this challenging condition. Larger, multicenter studies are needed to confirm these findings.</p>

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Utilization of flexible ureteroscopy in conjunction with flexible and navigable suction ureteral access sheaths for the management of 1–2 cm complex lower calyceal calculi

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Zengjun Zhu,
  • Wenyu Chi,
  • Chengrong Zhang,
  • Weihui Jia,
  • Guobao Sun

摘要

Purpose

To evaluate the efficacy and safety of flexible ureteroscopy (FURL) combined with flexible and navigable suction ureteral access sheaths (FANS) compared to conventional FURL for treating 1–2 cm complex lower calyceal stones.

Methods

A retrospective single-center study was conducted at the Affiliated Hospital of Shandong Second Medical University, analyzing patients treated between July 2023 and February 2025. Inclusion criteria were: (i) preoperative CT diagnosis of 1–2 cm single lower calyceal stones; (ii) preoperative intravenous urography (IVU) identifying direct insertion of minor calyces into the renal pelvis or branched fusion forming major calyceal openings; and (iii) surgeries performed by one fellowship-trained endourologist for procedural standardization. Exclusion criteria included: (i) uncontrolled preoperative urinary tract infections; (ii) significant ureteral strictures; (iii) severe cardiopulmonary dysfunction or coagulation disorders; (iv) unforeseen postoperative events unrelated to the procedure; and (v) incomplete perioperative data. Patients were divided into an intervention group (FURL with FANS) and a control group (standard FURL with conventional ureteral access sheath). Baseline characteristics, stone-free rates, operative time, hospital stay, and postoperative complications were compared using weighted t-tests, Chi-square tests, or Fisher’s exact test.

Results

The study included 69 patients (intervention group, n = 36; control group, n = 33). After inverse probability of treatment weighting(IPTW) adjustment, baseline characteristics, including age, sex, BMI, stone size, and stone density, showed no significant differences between groups (P > 0.05). The intervention group demonstrated a significantly higher stone-free rate (75.5% vs. 48.9%, P = 0.010), defined as residual fragments < 4 mm on CT at postoperative day 30, shorter operative time (63.02 ± 8.17 min vs. 73.92 ± 15.56 min, P < 0.001), shorter hospital stay (3.15 ± 0.46 days vs. 5.16 ± 1.35 days, P < 0.001), and lower incidence of postoperative fever (0% vs. 12.5%, P = 0.047).

Conclusions

FURL combined with FANS offers superior efficacy and safety compared to conventional FURL for managing 1–2 cm complex lower calyceal stones. This approach resulted in higher stone-free rates, reduced operative times, shorter hospital stays, and fewer postoperative complications, presenting a promising alternative for this challenging condition. Larger, multicenter studies are needed to confirm these findings.