Comparative evaluation of flexible and navigable suction sheath (FANS), percutaneous nephrostomy (PCN), and conventional ureteral access sheath (UAS) during retrograde intrarenal surgery: a randomized controlled trial.

Mohamed Abdelrahman Alhefnawy, T M El-Karamany, Mahmoud Farag, Mahmoud Mobarak, Islam Saied Ahmed Mohamed, Hussein Shaher

Abstract readRandomized Controlled TrialComparative Study

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Trial report in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Mohamed Abdelrahman AlhefnawyUrology Department, Faculty of Medicine, Benha University, Benha, Egypt. dr.mohamedalhefnawy@gmail.com.

T M El-KaramanyUrology Department, Faculty of Medicine, Benha University, Benha, Egypt.

Mahmoud FaragUrology Department, Faculty of Medicine, Benha University, Benha, Egypt.

Mahmoud MobarakUrology Department, Faculty of Medicine, Benha University, Benha, Egypt.

Islam Saied Ahmed MohamedUrology Department, Faculty of Medicine, Benha University, Benha, Egypt.

Hussein ShaherUrology Department, Faculty of Medicine, Benha University, Benha, Egypt.

Funding

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6 · The paper itself

Abstract

purposeOptimizing drainage during retrograde intrarenal surgery (RIRS) is crucial for procedural efficacy and safety. Flexible and navigable suction ureteral access sheath (FANS) offers active intrarenal suction without external access, while percutaneous nephrostomy (PCN) provides reliable but invasive drainage. This study compared the efficacy and safety of FANS versus PCN tube drainage during RIRS as compared to conventional ureteral access sheath (UAS).

methodsThis randomized controlled trial included 217 adult patients with renal stones (14-27 mm) undergoing RIRS. Patients were randomized into three groups: (UAS, n = 72), PCN (n = 72), and FANS (n = 73). Outcomes assessed included operative time, stone-free rate (SFR), complications, and postoperative recovery.

resultsSFR was significantly higher with PCN (97.2%) and FANS (98.6%) versus UAS (81.9%; p < 0.001). The mean operative time was shorter with PCN (48 ± 14 min) than UAS (58 ± 13 min) and FANS (58 ± 11 min; p < 0.001). Loin/suprapubic pain and hematuria were more frequent with UAS, whereas infectious and major complications were infrequent and similar. On stepwise multivariable analysis, lower Hounsfield units and use of PCN (OR 7.756, 95% CI 1.655-36.346) or FANS (OR 17.25, 95% CI 2.156-138.024) independently predicted stone-free status.

conclusionsPCN and FANS are both effective and safe drainage strategies during RIRS and outperform conventional UAS in SFR. FANS provides a minimally invasive, entirely endoscopic alternative to PCN with comparable safety and efficacy.

Indexed as

Kidney CalculiNephrostomy, PercutaneousAdultEquipment DesignFemaleHumansMaleMiddle AgedOperative TimeSuctionUreterFlexible and navigable suctionPercutaneous nephrostomyRenal stonesRetrograde intrarenal surgeryStone-free rateUreteral access sheath

Identifiers

PMID42014630

DOI10.1007/s00345-026-06410-4

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