Flexible aspiration navigable sheaths increase 30-day stone-free rates for renal calculi under 2 cmSuction-Assisted Tools Show Higher Success for Small Kidney Stones

World journal of urology Published September 11, 2026 Study authors: Hinojosa-Gonzalez David E, Gutierrez-Gamez Andres, Torres-Martinez Mauricio, Calvillo-Ramirez Alejan… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider FANS to improve 30-day stone-free rates and reduce sepsis risk in patients with renal calculi under 2 cm.

This systematic review and Bayesian network meta-analysis evaluated the efficacy of flexible aspiration navigable sheaths (FANS) and direct in-scope suction (DISS) compared to conventional access sheaths for treating renal calculi less than or equal to 2 cm. The analysis included data from 3657 patients to evaluate 30-day stone-free rates (SFR), operative time, and complications.

Key findings indicate that FANS showed a higher 30-day SFR with an OR 2.5 (95% CrI 2.0-3.1). DISS showed a higher 30-day SFR with an OR 3.1, though the results were less precise (95% CrI 1.0-8.8). Specifically, Calyxo V2 showed the highest SFR (OR 5.4, 95% CrI 1.0-29.0), while PUSEN showed no significant difference (OR 1.6, 95% CrI 0.41-6.3). FANS were associated with lower odds of postoperative sepsis (OR 0.40, 95% CrI 0.12-0.97) and reduced postoperative fever and complications.

Authors noted that DISS results are less precise and vary by technology configuration. The study highlights that suction-assisted ureteroscopy improves SFR for renal calculi under 2 cm, with FANS associated with shorter operative times and fewer complications. Larger prospective trials are needed to confirm these findings and address the variability in DISS performance.

How this fits prior evidence

This finding extends the evidence for managing renal calculi by identifying specific suction-assisted technologies that improve outcomes. It complements the finding that mPCNL yields higher single-session stone-free rates than RIRS for medium renal stones by providing a specific technological advantage for smaller stones. It also builds upon the use of specialized ureteral sheaths to improve outcomes in renal calculi surgery.

Researchers analyzed data from over 3,600 patients with kidney stones smaller than 2 cm. The study compared different types of suction-assisted tools, such as flexible aspiration navigable sheaths (FANS) and direct in-scope suction (DISS), against standard tools used during surgery.

The findings showed that patients treated with FANS had a higher rate of being stone-free after 30 days compared to those using standard tools. These patients also experienced fewer instances of fever and fewer overall complications. While DISS also showed a higher stone-free rate, the results for that specific tool were less precise and varied depending on the technology used.

Because the data for some tools were less precise and the study was a meta-analysis, these results are not yet definitive. Larger, prospective trials are still needed to confirm these findings. Patients should talk to their doctor to determine which surgical approach is best for their specific condition.

What this means for you:

Suction-assisted tools like FANS may improve stone-free rates and reduce complications for small kidney stones.

Common questions

What is the success rate for these new suction tools?

The study found that patients using flexible aspiration navigable sheaths (FANS) had a higher stone-free rate after 30 days compared to standard tools. While some other suction methods also showed higher rates, the results were less precise because of how the technology was set up.

Are these tools safer than traditional methods?

The data suggests that using FANS was associated with lower odds of postoperative sepsis and a reduction in fever and other complications. However, because some results were less precise, you should discuss the specific risks and benefits with your doctor.

Who specifically can benefit from these suction-assisted tools?

This finding specifically concerns patients with renal calculi (kidney stones) that are 2 cm or smaller. The study looked at how these tools perform in clearing those specific types of stones during surgery.

Study Details

Study typeSystematic review

Sample sizen = 3,657

EvidenceLevel 1

PublishedSep 2026

PMID42714596

View Original Abstract ↓

INTRODUCTION AND OBJECTIVE: Suction-enhanced flexible ureteroscopy (URS) aims to improve stone clearance and reduce complications. We performed a Bayesian network meta-analysis to compare the efficacy and safety of flexible aspiration navigable sheaths (FANS) and direct in-scope suction (DISS) for renal calculi ≤ 2 cm. METHODS: A systematic search of PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar was conducted through June 2026. Comparative studies of FANS, DISS, or conventional access sheaths for renal stones ≤ 2 cm were included. The primary outcome was 30-day stone-free rate (SFR). Secondary outcomes included operative time, fever, sepsis, and complications. A Bayesian random-effects network meta-analysis synthesized direct and indirect evidence. RESULTS: Seventeen studies including 3,657 patients (1,677 FANS, 56 DISS, 1,924 control) were included. FANS showed higher SFR (OR 2.5, 95% CrI 2.0-3.1), while grouped DISS had a similar but less precise effect (OR 3.1, 95% CrI 1.0-8.8). Calyxo V2 had the highest SFR (OR 5.4, 95% CrI 1.0-29.0), whereas PUSEN showed no significant difference (OR 1.6, 95% CrI 0.41-6.3). FANS reduced postoperative fever and complications. FANS also showed lower odds of postoperative sepsis (OR 0.40, 95% CrI 0.12-0.97). CONCLUSIONS: Suction-assisted ureteroscopy improves SFR for renal calculi ≤ 2 cm. FANS was associated with shorter operative time, fever, and complications. DISS systems show promising but limited results, with performance differing by technology configuration. Larger prospective trials are needed.

Flexible aspiration navigable sheaths increase 30-day stone-free rates for renal calculi under 2 cmSuction-Assisted Tools Show Higher Success for Small Kidney Stones

How this fits prior evidence

Common questions

Study Details

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Flexible aspiration navigable sheaths increase 30-day stone-free rates for renal calculi under 2 cmSuction-Assisted Tools Show Higher Success for Small Kidney Stones

How this fits prior evidence

Common questions

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