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Background <p>Management of upper urinary tract stones with moderate-to-severe hydronephrosis remains challenging due to altered renal anatomy and higher complication risks. Flexible negative-pressure ureteral sheath lithotripsy (FANS) has emerged as a minimally invasive alternative to miniaturized percutaneous nephrolithotomy (mini-PCNL). This study compared the efficacy and safety of FANS and mini-PCNL in this patient population.</p> Methods <p>A total of 125 patients with upper urinary tract stones and moderate-to-severe hydronephrosis who underwent either FANS (<i>n</i> = 57) or mini-PCNL (<i>n</i> = 68) between June 2024 and June 2025 were retrospectively analyzed. Baseline demographics, stone characteristics, operative parameters, perioperative laboratory changes, hospital stay, immediate stone-free rate (SFR) and finial SFR, and postoperative complications were assessed.</p> Results <p>Baseline characteristics (age, BMI, stone burden, comorbidities, and hydronephrosis degree) were comparable between groups. The FANS group had a longer operative time (70 vs. 60&#xa0;min, <i>P</i> = 0.006) but a shorter stay of hospital (2 vs. 3 days, <i>P</i> = 0.008) and smaller hemoglobin drop (8.0 vs. 11.0&#xa0;g/L, <i>P</i> = 0.031). WBC changes, eGFR drop, immediate SFR (80.7% vs. 80.9%) and finial SFR (89.5% (51/57) vs. 88.2% (60/68)) were similar. The overall complication rate was lower with FANS (5.9% (4/57) vs. 25.0% (17/68), <i>P</i> = 0.011), and no severe complications occurred, whereas mini-PCNL included several Grade 3b events.</p> Conclusions <p>Both FANS and mini-PCNL achieved comparable stone clearance in moderate-to-severe hydronephrosis. However, FANS offered reduced bleeding, faster recovery, and fewer complications, indicating its potential role as a safer and less invasive option for patients with complex upper urinary tract anatomy.</p>

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Flexible negative-pressure ureteral sheath lithotripsy compared with mini-PCNL for upper urinary tract stones with moderate-to-severe hydronephrosis: a retrospective clinical study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月19日

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  • Wei Hao,
  • Junxiu Hao,
  • Min Zhang,
  • Huimin Zhang,
  • Chao Yang

摘要

Background

Management of upper urinary tract stones with moderate-to-severe hydronephrosis remains challenging due to altered renal anatomy and higher complication risks. Flexible negative-pressure ureteral sheath lithotripsy (FANS) has emerged as a minimally invasive alternative to miniaturized percutaneous nephrolithotomy (mini-PCNL). This study compared the efficacy and safety of FANS and mini-PCNL in this patient population.

Methods

A total of 125 patients with upper urinary tract stones and moderate-to-severe hydronephrosis who underwent either FANS (n = 57) or mini-PCNL (n = 68) between June 2024 and June 2025 were retrospectively analyzed. Baseline demographics, stone characteristics, operative parameters, perioperative laboratory changes, hospital stay, immediate stone-free rate (SFR) and finial SFR, and postoperative complications were assessed.

Results

Baseline characteristics (age, BMI, stone burden, comorbidities, and hydronephrosis degree) were comparable between groups. The FANS group had a longer operative time (70 vs. 60 min, P = 0.006) but a shorter stay of hospital (2 vs. 3 days, P = 0.008) and smaller hemoglobin drop (8.0 vs. 11.0 g/L, P = 0.031). WBC changes, eGFR drop, immediate SFR (80.7% vs. 80.9%) and finial SFR (89.5% (51/57) vs. 88.2% (60/68)) were similar. The overall complication rate was lower with FANS (5.9% (4/57) vs. 25.0% (17/68), P = 0.011), and no severe complications occurred, whereas mini-PCNL included several Grade 3b events.

Conclusions

Both FANS and mini-PCNL achieved comparable stone clearance in moderate-to-severe hydronephrosis. However, FANS offered reduced bleeding, faster recovery, and fewer complications, indicating its potential role as a safer and less invasive option for patients with complex upper urinary tract anatomy.