ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2026
Retrograde intrarenal surgery with flexible and navigable suction ureteral access sheaths vs. percutaneous nephrolithotomy for 2-3 cm kidney stones Is less invasive better?
Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Safety and efficacy of percutaneous nephrolithotomy in elderly patients: a systematic review and meta-analysis by the EAU-YAU urolithiasis and EAU endourology sections.World journal of urology · 2026Pooled it
- Global variation in acquisition costs of single-use flexible ureteroscopes and flexible navigable access sheaths: an international collaborative analysis from the YAU & EAU Endourology groups.World journal of urology · 2026Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe management of renal stones measuring 2-3 cm remains a clinical challenge, with percutaneous nephrolithotomy (PCNL) traditionally favored over retrograde intrarenal surgery (RIRS) due to higher stone-free rates (SFR); however, advancements in flexible ureteroscopy and the introduction of flexible and navigable suction ureteral access sheaths (FANS-UAS) have expanded the role of RIRS for larger stones. This study compares the efficacy and safety of PCNL vs. FANS-UAS-assisted RIRS for medium-sized renal calculi.
methodsThis retrospective study included 116 patients (50 RIRS, 66 PCNL) with 2-3 cm renal stones treated at a single institution. RIRS was performed using an 11/13 Fr FANSUAS, while PCNL followed standard techniques. Outcomes assessed included operative time, hospitalization, hemoglobin drop, SFR (defined as no fragments ≥1 mm on three-month computed tomography), and complications (Clavien-Dindo).
resultsBaseline characteristics were comparable between groups (p>0.05). RIRS demonstrated significantly shorter operative times (63.1±11.3 vs. 97.3±15.1 minutes, p<0.001) and hospitalization (28.3±17.9 vs. 81±24.8 hours, p<0.001), with less hemoglobin drop (0.4±0.5 vs. 2.1±1.7 g/dL, p<0.001). SFRs were similar at three months (70% RIRS vs. 74.2% PCNL, p=0.677). PCNL had higher complication rates, including three grade III events (vs. none in RIRS), although this was not statistically significant (p=0.277).
conclusionsFANS-UAS-assisted RIRS offers comparable SFRs to PCNL for 2-3 cm stones, with advantages in operative efficiency, hospitalization, and perioperative safety. These findings suggest RIRS as a viable minimally invasive alternative, warranting further randomized trials to validate its role in this setting.
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