Efficacy of a flexible navigable suction access sheath during retrograde intrarenal surgery for 1–3 cm renal calculi: a comparative analysis

Hao Wang^1,#, Yijie Xie^1,#, Meixuan Ding^2,#, He Gong³, Qi Zheng³, Jiaxin Zheng³, Bo Duan³, Tao Wang^3,*, Peide Bai^3,*, Bin Chen^1,*
1 The Graduate School of Fujian Medical University, Fuzhou, China
2 Xinglin Hospital of Xiamen University, Xiamen, China
3 Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
* Corresponding Author: Tao Wang. Email: email ; Peide Bai. Email: email ; Bin Chen. Email: email
# These authors contributed equally to this work as the first author
(This article belongs to the Special Issue: Advances in Endoscopic Management of Urolithiasis)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.082776

Received 23 March 2026; Accepted 18 June 2026; Published online 24 July 2026

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Abstract

Objective: Although retrograde intrarenal surgery is a common approach for kidney stones, successfully eliminating 1–3 cm calculi is often hindered by inadequate aspiration and the dangers of elevated intrarenal pressure. This research evaluated the clinical effectiveness and safety profile of utilizing a flexible and navigable suction ureteral access sheath (FANS) versus a traditional ureteral access sheath (T-UAS) for managing 1–3 cm renal calculi during flexible ureteroscopy. Methods: We conducted a retrospective review of 338 individuals treated for 1–3 cm kidney stones from May 2024 to November 2025. Participants were categorized into either a FANS cohort (n = 169) or a T-UAS cohort (n = 169). Patient demographics, operative metrics, and postoperative adverse events were assessed and compared. Results: Baseline parameters were well-matched, with the exception of a significantly greater stone burden in the FANS cohort (p = 0.003). Compared to the T-UAS group, the FANS approach required fewer disposable stone baskets, incurred lower hospitalization expenses, and achieved a substantially better stone-free rate (SFR, defined as residual fragments <2 mm) on the first postoperative day (p < 0.001). Although the FANS procedure took longer, it was associated with a smaller drop in hemoglobin, a reduced likelihood of pain complications, and a faster hospital discharge (p = 0.008, p = 0.006, and p = 0.007, respectively). At one month, both the SFR and complication frequencies were statistically comparable between the two groups (p > 0.05). Conclusion: Even with a prolonged surgical duration, the FANS system provided superior immediate stone clearance, decreased reliance on auxiliary baskets, and promoted faster recovery than T-UAS, all while maintaining a comparable safety profile. While final one-month success rates were similar, FANS enabled highly efficient intraoperative stone evacuation. Given the retrospective baseline differences, these outcomes should be interpreted with care and validated by future prospective studies.