Flexible ureteroscopy with a flexible and navigable suction ureteral access sheath versus mini-percutaneous nephrolithotomy for renal stones larger than 2 cm in patients with a solitary kidney: a propensity score-matched and win ratio analysis.

Authors

Jinghua Zhong, Ziteng Shen, Zijie Chai, Jingzeng Du, Yang Xiao, Shusheng Liu, Wenhao Chen, Ji Li, Francesco Traina, Wen Zhong, Zhijian Zhao, Yongda Liu, Guohua Zeng, Wei Zhu

Published in

World journal of urology. Volume 44. Issue 1. Jul 12, 2026. Epub Jul 12, 2026.

Abstract

To compare the efficacy and safety of flexible ureteroscopy using a flexible and navigable suction ureteral access sheath (FANS f-URS) with mini-percutaneous nephrolithotomy (mini-PCNL) for > 2 cm renal stones in patients with a solitary kidney.
This retrospective study included patients with a solitary kidney and renal stones > 2 cm who underwent either FANS f-URS or mini-PCNL between July 2023 and January 2026. Propensity score matching (PSM) was performed in a 1:2 ratio. The primary analysis consisted of a pair-matched win ratio analysis using a hierarchical composite endpoint comprising postoperative complications, 1-month stone-free rate (SFR), and length of postoperative hospital stay. Perioperative outcomes and postoperative complications were also compared between the two groups.
After PSM, 88 patients were included (41 FANS f-URS and 47 mini-PCNL). In the win ratio analysis, FANS f-URS demonstrated significantly greater overall clinical benefit than mini-PCNL (win ratio = 4.12, 95% CI 1.50-21.02, p < 0.001). Although mini-PCNL achieved a significantly higher immediate SFR, the 1-month SFR was comparable between the two groups after second-stage treatment. Compared with mini-PCNL, FANS f-URS was associated with significantly lower postoperative morbidity, reduced hemoglobin decrease, shorter hospitalization, lower postoperative pain scores, and greater improvement in quality of life.
In patients with a solitary kidney and renal stones > 2 cm, a staged FANS f-URS strategy achieved a 1-month SFR comparable to that of mini-PCNL while offering a lower risk of complications and improved postoperative recovery. FANS f-URS may represent a safer and less invasive treatment strategy for this high-risk population.

PMID:
42437413
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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