Single-use versus reusable flexible ureterorenoscopes with FANS: a multicenter propensity-matched analysis of outcomes in a large series from the EAU-Endourology Section and FANS Collaborative Group.

Authors

Carlo Giulioni, Daniele Castellani, Federico Falsetti, Naeem Bhojani, Ben Hall Chew, Steffi Kar Kei Yuen, Anil Shrestha, Pablo Contreras, Sundaram Palaniappan, Tsung Wen Chong, Angelo Cafarelli, Wei Zhu, Guohua Zeng, Yi Tan Quan, Jia-Lun Kwok, Khi Yung Fong, Amelia Pietropaolo, Thomas Herrmann, Olivier Traxer, Bhaskar Kumar Somani, Vineet Gauhar

Published in

World journal of urology. Volume 43. Issue 1. Pages 399. Jun 26, 2025. Epub Jun 26, 2025.

Abstract

This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).
A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, n = 263) and those with reusable fURS (Group 2, n = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with p < 0.05 considered significant.
After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD < 0.1). Group 1 was associated with shorter laser (p = 0.001) and operative times (p = 0.048), and more frequent use of larger sheaths (p < 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, p = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups. On multivariate analysis, single-use scope use (OR 1.659, p = 0.018) and 10-12 Fr UAS (OR 1.749, p = 0.043) were significantly associated with complete stone clearance.
Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.

PMID:
40569462
Bibliographic data and abstract were imported from PubMed on 26 Jun 2025.

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