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Flexible ureteroscopy with FANS shows comparable stone-free rates to mPCNL for 2-3 cm stonesNewer procedure shows promise for treating large kidney stones

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Key Takeaway
Note that FANS provides comparable stone-free rates to mPCNL for 2-3 cm stones with reduced blood loss.

This randomized controlled trial evaluated the efficacy of flexible ureteroscopy (f-URS) with a flexible and navigable suction ureteral access sheath (FANS) compared to mini-percutaneous nephrolithotomy (mPCNL) in 326 patients with 2-3 cm upper urinary tract stones. The primary outcome was the stone-free rate (SFR) at immediate and 1-month follow-up.

In the overall 2-3 cm cohort, the stone-free rate for the FANS group was comparable to the mPCNL group. In the specific subgroup of stones measuring 2 to <2.5 cm, the FANS group was non-inferior to mPCNL at both time points. Regarding secondary outcomes, the FANS group experienced significantly less hemoglobin loss and shorter hospital stays compared to the mPCNL group. However, operative time was longer in the FANS group for the overall cohort, though it was not significantly longer in the 2 to <2.5 cm subgroup.

Safety data showed no significant difference in infection-related complications between the two groups. FANS may be considered an effective alternative to mPCNL for 2-3 cm stones and may be a preferred option for stones measuring 2-2.5 cm. Clinical application should consider the trade-off between longer operative times and reduced blood loss and hospital stay duration.

Living with large kidney stones in the upper urinary tract can be a painful and serious experience. Doctors often have to choose between different surgical methods to remove these stones. A recent study looked at two specific methods for patients with stones measuring between 2 and 3 centimeters.

The study compared a standard procedure called mini-percutaneous nephrolithotomy with a newer technique using a flexible ureteroscopy and a special suction sheath. The results showed that both methods were equally effective at clearing the stones. However, the newer technique led to less blood loss and shorter hospital stays for the patients.

While the newer method took longer to perform in some cases, it was just as fast as the standard method for stones slightly smaller than 2.5 centimeters. There was no difference in infection rates between the two groups. This suggests the newer tool is a strong alternative for treating these large stones.

What this means for you:
A new surgical tool clears large kidney stones as well as standard methods but reduces blood loss and hospital time.

Common questions

Is the new procedure as effective as standard surgery?

Yes, the study found that the newer method using a flexible ureteroscopy and suction sheath was comparable to the standard mini-percutaneous nephrolithotomy for clearing stones between 2 and 3 centimeters. Both methods were equally successful at removing the stones at the one-month follow-up.

Are there any safety risks with the new method?

The study found no significant difference in infection-related complications between the two surgical methods. Both procedures were effective at clearing the stones, and the newer method did not show a higher risk of infection compared to the standard treatment.

How does the recovery time compare between the two methods?

Patients who underwent the newer procedure with the suction sheath had shorter hospital stays compared to those who had the standard surgery. While the newer method took longer to perform in some cases, it resulted in less blood loss for the patients.

Study Details

Study typeRct
Sample sizen = 326
EvidenceLevel 2
Follow-up1.0 mo
PublishedOct 2026
View Original Abstract ↓
OBJECTIVE: To evaluate the safety and efficacy of flexible ureteroscopy (f-URS) with a flexible and navigable suction ureteral access sheath (FANS) compared with mini-percutaneous nephrolithotomy (mPCNL) in the treatment of 2-3 cm upper urinary tract stones (UUTS), with a prespecified subgroup analysis for stones ≥2 to <2.5 cm. METHODS: This randomized controlled trial enrolled 326 patients with 2-3 cm UUTS between June 2023 and December 2025. Patients were randomly assigned in a 1:1 ratio to undergo either f-URS with FANS or mPCNL. A prespecified subgroup analysis was conducted for stones measuring ≥2 to <2.5 cm. The primary outcomes were the immediate and 1-month stone-free rate (SFR). Secondary outcomes included the operative duration, decrease in haemoglobin, hospital stay, and complication rate. RESULTS: The baseline characteristics were comparable between the two groups. In the overall 2-3 cm cohort, the FANS group achieved immediate and 1-month SFRs comparable to those of the mPCNL group. Although the operative time was longer in the FANS group, it was associated with significantly less haemoglobin loss and a shorter hospital stay, with no significant difference in infection-related complications. Notably, in the subgroup of stones ≥2 to <2.5 cm, the FANS group demonstrated a non-inferior SFR at both time points, and the operative time was not significantly longer than that of the mPCNL group. CONCLUSION: For 2-3 cm UUTS, f-URS with FANS offers a SFR comparable to that of mPCNL, along with the advantages of reduced blood loss and shorter hospitalization. In the ≥2 to <2.5 cm subgroup, FANS shows comprehensive benefits over mPCNL. These findings support FANS as an effective alternative to mPCNL for 2-3 cm stones and a potentially preferred option for stones measuring 2-2.5 cm.
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