Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

被引：12

作者：

Kwok, Jia-Lun ^{[1
,2
]}

Somani, Bhaskar ^{[3
]}

Sarica, Kemal ^{[4
,5
]}

Yuen, Steffi Kar Kei ^{[6
]}

Zawadzki, Marek ^{[7
]}

Castellani, Daniele ^{[8
]}

Persaud, Satyendra ^{[9
]}

Chai, Chu Ann ^{[10
]}

Kamal, Wissam ^{[11
]}

Tefik, Tzevat ^{[12
]}

Tursunkulov, Azimdjon N. ^{[13
]}

Soebhali, Boyke ^{[14
]}

El Hajj, Albert ^{[15
]}

Ko, Raymond ^{[16
]}

Fong, Khi Yung ^{[17
]}

Dragos, Laurian ^{[18
]}

Tanidir, Yiloren ^{[19
]}

Angerri, Oriol ^{[20
]}

Traxer, Olivier ^{[2
,21
]}

Gauhar, Vineet ^{[2
,22
]}

机构：

[1] Tan Tock Seng Hosp, Dept Urol, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

[2] Progress Endourol Assoc Res & Leading Solut PEARLS, Paris, France

[3] Univ Hosp Southampton NHS Trust, Dept Urol, Southampton, England

[4] Prof Dr Ilhan Varank Training & Res Hosp, Dept Pediat, Istanbul, Turkiye

[5] Biruni Univ, Sch Med, Dept Urol, Istanbul, Turkiye

[6] Chinese Univ Hong Kong, SH Ho Urol Ctr, Dept Surg, Hong Kong, Peoples R China

[7] St Anna Hosp, Urol Unit, Piaseczno, Poland

[8] Univ Politecn Marche, Azienda Osped Univ Marche, Urol Unit, Ancona, Italy

[9] Univ West Indies, Div Clin Surg Sci, St Augustine, Trinidad Tobago

[10] Univ Kebangsaan Malaysia, Dept Surg, Urol Unit, Kuala Lumpur, Malaysia

[11] King Fahd Gen Hosp, Urol Unit, Jeddah, Saudi Arabia

[12] Istanbul Univ, Istanbul Fac Med, Dept Urol, Istanbul, Turkiye

[13] AkfaMedline Hosp, Dept Urol, Tashkent, Uzbekistan

[14] Abdul Wahab Sjahranie Hosp, Abdul Wahab Sjahranie Hosp, Dept Urol, Med Fac, Samarinda, Indonesia

[15] Amer Univ Beirut, Dept Surg, Div Urol, Beirut, Lebanon

[16] Univ Sydney, Nepean Hosp, Dept Urol, Sydney, Australia

[17] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[18] Cambridge Univ Hosp NHS Fdn Trust, Cambridge, England

[19] Marmara Univ, Sch Med, Dept Urol, Istanbul, Turkiye

[20] Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain

[21] Sorbonne Univ, Hop Tenon, AP HP, GRC 20 LITHIASE RENALE, F-75020 Paris, France

[22] Ng Teng Fong Gen Hosp, Dept Urol, Singapore, Singapore

来源：

UROLITHIASIS | 2024年 / 52卷 / 01期

关键词：

Flexible ureteroscopy; Lithotripsy; Flexible and navigable suction ureteral access sheaths; Suction; Sheath size;

D O I：

10.1007/s00240-024-01662-4

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm(3), p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment <= 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.

引用

页数：9

共 28 条

[1] Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust? [J].

Aldoukhi, Ali H. ;

Roberts, William W. ;

Hall, Timothy L. ;

Ghani, Khurshid R. .

FRONTIERS IN SURGERY, 2017, 4

[2] Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study [J].

Alkhamees, Mohammad ;

Aljuhayman, Ahmed ;

Addar, Abdulmalik ;

Ghazwani, Yahya ;

Alasker, Ahmed ;

Hamri, Saeed Bin .

UROLOGY ANNALS, 2020, 12 (04) :331-334

[3] Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR) [J].

Chai, Chu-Ann ;

Teoh, Yuen -Chun ;

Tailly, Thomas ;

Emiliani, Esteban ;

Inoue, Takaaki ;

Tanidir, Yiloren ;

Gadzhiev, Nariman ;

BIN Hamri, Saeed ;

Ong, William L. ;

Shrestha, Anil ;

Ragoori, Deepak ;

Lakmichi, Mohamed A. ;

Gorelov, Dmitry ;

Soebhali, Boyke ;

Vaddi, Chandra M. ;

Bhatia, Tanuj P. ;

Desai, Devang ;

Durai, Pradeep ;

Heng, Chin-Tiong ;

Chew, Ben ;

Castellani, Daniele ;

Somani, Bhaskar ;

Traxer, Olivier .

MINERVA UROLOGY AND NEPHROLOGY, 2023, 75 (04) :493-500

[4] Clinical efficacy analysis of tip-flexible suctioning ureteral access sheath combined with disposable flexible ureteroscope to treat 2-4 cm renal stones [J].

Chen, Hua ;

Xiao, Jiansheng ;

Ge, Jiaqi ;

Liu, Tairong .

INTERNATIONAL UROLOGY AND NEPHROLOGY, 2024, 56 (10) :3193-3199

[5] Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review [J].

De Coninck, Vincent ;

Somani, Bhaskar ;

Sener, Emre Tarik ;

Emiliani, Esteban ;

Corrales, Mariela ;

Juliebo-Jones, Patrick ;

Pietropaolo, Amelia ;

Mykoniatis, Ioannis ;

Hameed, Belthangady M. Zeeshan ;

Esperto, Francesco ;

Proietti, Silvia ;

Traxer, Olivier ;

Keller, Etienne Xavier .

JOURNAL OF CLINICAL MEDICINE, 2022, 11 (17)

[6] Systematic review of ureteral access sheaths: facts and myths [J].

De Coninck, Vincent ;

Keller, Etienne Xavier ;

Rodriguez-Monsalve, Maria ;

Audouin, Marie ;

Doizi, Steeve ;

Traxer, Olivier .

BJU INTERNATIONAL, 2018, 122 (06) :959-969

[7] Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults [J].

Delgado, Domenica A. ;

Lambert, Bradley S. ;

Boutris, Nickolas ;

McCulloch, Patrick C. ;

Robbins, Andrew B. ;

Moreno, Michael R. ;

Harris, Joshua D. .

JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS, 2018, 2 (03)

[8] The Effect of Ratio of Endoscope-Sheath Diameter on Intrapelvic Pressure During Flexible Ureteroscopic Lasertripsy [J].

Fang, Li ;

Xie, Guohai ;

Zheng, Zhong ;

Liu, Wanzhang ;

Zhu, Jiaqi ;

Huang, Ting ;

Lu, Yunfei ;

Cheng, Yue .

JOURNAL OF ENDOUROLOGY, 2019, 33 (02) :132-139

[9] Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Outcomes at 30 Days from a Large, Prospective, Multicenter, Real-world Study by the European Association of Urology Urolithiasis Section [J].

Gauhar, Vineet ;

Traxer, Olivier ;

Castellani, Daniele ;

Sietz, Christian ;

Chew, Ben Hall ;

Fong, Khi Yung ;

Bin Hamri, Saeed ;

Gadzhiev, Nariman ;

Galosi, Andrea Benedetto ;

Yuen, Steffi Kar Kei ;

El Hajj, Albert ;

Ko, Raymond ;

Zawadzki, Marek ;

Sridharan, Vikram ;

Lakmichi, Mohamed Amine ;

Corrales, Mariela ;

Malkhasyan, Vigen ;

Ragoori, Deepak ;

Soebhali, Boyke ;

Tan, Karl ;

Chai, Chu Ann ;

Tursunkulov, Azimdjon N. ;

Gokce, Mehmet Ilker ;

Tanidir, Yiloren ;

Persaud, Satyendra ;

Elshazly, Mohamed ;

Kamal, Wissam ;

Tefik, Tzevat ;

Shrestha, Anil ;

Tiong, Heng Chin ;

Somani, Bhaskar Kumar .

EUROPEAN UROLOGY FOCUS, 2024, 10 (06) :975-982

[10] Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group [J].

Gauhar, Vineet ;

Castellani, Daniele ;

Chew, Ben Hall ;

Smith, Daron ;

Chai, Chu Ann ;

Fong, Khi Yung ;

Teoh, Jeremy Yuen-Chun ;

Traxer, Olivier ;

Somani, Bhaskar Kumar ;

Tailly, Thomas .

THERAPEUTIC ADVANCES IN UROLOGY, 2023, 15

← 1 2 3 →