A comparative study of flexible and navigable suction ureteral access sheath combined with single-use flexible ureteroscopes and percutaneous nephrolithotomy in the treatment of kidney stones > 2.5 cm: a single-center retrospective study.

Background And Objective: When performing retrograde intrarenal surgery (RIRS), compared with conventional ureteral access sheaths (UAS), flexible and navigable suction ureteral access sheaths (FANs) can reduce the number of lithotripsy sessions and increase the stone-free rate (SFR). They have been widely applied in flexible ureteroscopic lithotripsy (FURL). Currently, ureteroscopic flexible ureteroscopes equipped with FANs are also showing remarkable outcomes in the treatment of large kidney stones. Therefore, the objective of this study was to explore the efficacy of single-use flexible ureteroscopes (su-fURS) combined with FANs in the treatment of kidney stones larger than 2.5 cm and to compare it with percutaneous nephrolithotomy (PCNL).

Methods: Data of patients who underwent treatment of 2.5-3.8 cm kidney stones in the First Affiliated Hospital of Shandong Second Medical University from January 2024 to December 2024 were included in the study. According to the different surgical methods, they were divided into PCNL group and FANs group. The general data, intraoperative and postoperative related data of the patients in the two groups were collected and compared, where P < 0.05 represents statistical significance.

Results: A total of 76 patients (41 PCNL, 35 FANs) were included in this study, and both groups achieved a very favorable SFR (85%, 93% vs. 80%, 91% P = 0.536, 0.840), and the difference was not statistically significant. The PCNL group had a shorter mean operative time (99.39 vs. 135.49 min P < 0.001) and a lower mean hospitalization cost (22, 865.60 vs. 26,031.91 ¥ P < 0.001). The FANs had a lower level of postoperative hemoglobin (Hb) drop (6.31 vs. 11.05 g/L P = 0.010) and a less severe level of postoperative pain (1.97 vs. 3.41 points P < 0.001), faster postoperative recovery (3.29 vs. 6.54d P < 0.001).

Conclusions: FANs combined with su-FURS for the treatment of kidney stones larger than 2.5 cm have a high SFR, with less pain and quicker recovery for patients, making it a method worth promoting and applying in the clinic.