Investig Clin Urol.
2025 May;66(3):236-244. 10.4111/icu.20250071.
Can flexible ureteroscopy using flexible and navigable suction ureteral access sheath (FANS-UAS) minimize postoperative double J stent placement? Results from a propensity score-matched analysis of 540 patients of the European Association of Urology Section of Endourology and global FANS collaborative study group
- Castellani D
1,2 - Somani BK2,3
- Fong KY4
- Yuen SKK2,5
- Heng CT6
- Elshazly M7
- Tan K8
- Herrmann TRW2,9
- Traxer O2,10
- Gauhar V2,6
- Affiliations
-
- 1Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- 2European Association of Urology Section of Endourology, Arnhem, The Netherlands
- 3Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
- 4Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 5SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
- 6Department of Urology, Ng Teng Fong General Hospital, Singapore
- 7Urology Unit, Menoufia University, Shibin el Kom, Egypt
- 8Department of Surgery, Section of Urology, Veterans Memorial Medical Center, Quezon City, Philippines
- 9Spital Thurgau AG (STGAG), Frauenfeld, Switzerland
- 10Department of Urology, Tenon Hospital, AP-HP Sorbonne University, Paris, France
- KMID: 2567750
- DOI: http://doi.org/10.4111/icu.20250071
Abstract
- Purpose
To evaluate whether using flexible and navigable suction ureteral access sheath can obviate insertion of double J stent and establish the safety of overnight ureteric catheter placement as alternative following flexible ureteroscopy for kidney stones.
Materials and Methods
Five hundred forty adults were prospectively enrolled across 25 centers (from April 2023 to January 2024). Patients were divided into group 1 (overnight ureteric catheter), and group 2 (double J stent). Surgeons could choose either modality as per their discretion. One-to-one propensity score-matching for age, sex, pre-stenting, Hounsfield units, stone volume and location was performed. Thirty-day computed tomography scan was done to estimate stone-free status.
Results
After matching, 120 patients were included in each group. Group 1 had significantly shorter lasing, ureteroscopy, surgical time. Median day 1 loin pain score was similar (1 [1, 2] in both groups). Median postoperative stay was shorter in group 1 (0 days [0, 1] vs. 1 day [0, 2], p<0.001). One patient in group 2 required a blood transfusion. Incidence of fever was similar (5.0% vs. 0.8%). Loin/abdominal pain requiring medication occurred in one patient in group 2. Stent-related symptoms occurred in 2 patients in group 1. Three patients (2.5%) in group 1 and 2 patients (1.7%) in group 2 required readmission. Thirty-day stone-free status was higher in group 1 patients (79.2% vs. 56.7%).
Conclusions
In selected patients after thorough inspection to ensure no injury or residual fragments remain, placing an overnight ureteric catheter can be a safe alternative to a double J stent.
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