{
    "abstract": "This study compares the efficacy and safety of two techniques for flexible ureteroscopy (FURS) in managing 2-3\u00a0cm lower pole renal stones: the use of flexible and navigable access sheath (FANS) versus direct in-scope suction (DISS) without an access sheath. A retrospective analysis of 60 patients undergoing FURS for lower pole renal stones was conducted between March 2023 and January 2025. Group 1 (n\u2009=\u200932) underwent FANS-assisted procedures, while Group 2 (n\u2009=\u200928) underwent sheathless FURS with DISS. Stone-free rates (SFR) were assessed with non-contrast computed tomography (NCCT) after four weeks. Operative time, peri- and postoperative complications, and hospitalization duration were also compared. The mean operative time was significantly shorter in the FANS group (71.8\u2009\u00b1\u200911.5\u00a0min) compared to the DISS group (79.1\u2009\u00b1\u200911.7\u00a0min, p\u2009=\u20090.026). The difference between the SFRs obtained in the FANS group (62.5%) and the DISS group (46.4%) after the first session was not statistically significant (p\u2009=\u20090.162). After the second session, SFRs were also comparable (87.5% vs. 82.1%, p\u2009=\u20090.412) (Residual stones\u2009<\u20094\u00a0mm were considered stone-free). Completely stone-free rates (CSFR), defined as the absence of residual fragments after the first session were 43.7% in the FANS group and 32.1% in the DISS group (p\u2009=\u20090.256), while after the second session, these rates increased to 84.3% and 75%, respectively (p\u2009=\u20090.280). Postoperative fever rates (9.3% vs. 10.7%, p\u2009=\u20090.598) and hospitalization duration (2.5\u2009\u00b1\u20091.3 vs. 2.6\u2009\u00b1\u20091.4 days, p\u2009=\u20090.819) were similar. Both techniques achieved high overall SFRs for large lower pole stones in a staged manner. However, FANS was associated with a shorter operative time. While DISS eliminates the need for an access sheath, its longer operative time may be a limitation. Larger studies are needed to further evaluate these techniques.",
    "authors": [
        {
            "affiliation": "Department of Urology, Faculty of Medicine, Kafkas University, Kars, T\u00fcrkiye. dr.umityildirim87@gmail.com.",
            "firstname": "\u00dcmit",
            "initials": "\u00dc",
            "lastname": "Yildirim"
        },
        {
            "affiliation": "Department of Urology, Faculty of Medicine, Kafkas University, Kars, T\u00fcrkiye.",
            "firstname": "Mehmet",
            "initials": "M",
            "lastname": "Uslu"
        },
        {
            "affiliation": "Department of Urology, Faculty of Medicine, Kafkas University, Kars, T\u00fcrkiye.",
            "firstname": "Mehmet",
            "initials": "M",
            "lastname": "Ezer"
        },
        {
            "affiliation": "Department of Urology, Faculty of Medicine, Kafkas University, Kars, T\u00fcrkiye.",
            "firstname": "\u00c7a\u011flayan",
            "initials": "\u00c7",
            "lastname": "Erdo\u011fdu"
        },
        {
            "affiliation": "Department of Urology, Faculty of Medicine, Kafkas University, Kars, T\u00fcrkiye.",
            "firstname": "Ramazan",
            "initials": "R",
            "lastname": "Kocaaslan"
        },
        {
            "affiliation": "Department of Urology, Sancaktepe \u015eehit Prof.Dr. \u0130lhan Varank Training And Research Hospital, Istanbul, T\u00fcrkiye.\nDepartment of Urology, Faculty of Medicine, Biruni University, Istanbul, T\u00fcrkiye.",
            "firstname": "Kemal",
            "initials": "K",
            "lastname": "Sarica"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1007/s00240-025-01748-7",
    "journal": "Urolithiasis",
    "keywords": [
        "Access sheath",
        "Direct in scope",
        "Flexible",
        "Lower pole",
        "Navigable",
        "Suction"
    ],
    "methods": null,
    "publication_date": "2025-04-19",
    "pubmed_id": "40252099\n18308086\n38398427\n29149365\n38340165\n38017651\n39930287\n38731026\n39319828\n24451091\n37973416\n33638144\n38430305\n39361036\n36233577\n22982421\n37109152\n30729311\n37728745\n20039823\n26816715",
    "results": null,
    "title": "Comparison of flexible ureteroscopic suction techniques: efficacy and safety of flexible and navigable access sheath (FANS) vs. direct in-scope suction (DISS) in the management of 2-3\u00a0cm lower pole renal stones.",
    "xml": "<Element 'PubmedArticle' at 0x788505d7d530>"
}