Flexible Ureteroscopy and Laser Lithotripsy Using a Flexible and Navigable Ureteral Access Sheath Are Equally Safe and Effective whether Done in a Sitting or a Standing Position: A Multicenter Study by European Association of Urology-Endourology and the Flexible and Navigable Suction Access Sheath Collaborative Group
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Issued Date
2025-01-01
Resource Type
ISSN
08927790
eISSN
1557900X
Scopus ID
2-s2.0-105012036345
Journal Title
Journal of Endourology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Endourology (2025)
Suggested Citation
Fong K.Y., Somani B., Juliebø-Jones P., Castellani D., Heng C.T., Kwok J.L., Chai C.A., Kamal W., Ketsuwan C., Petkova K., Soebhali B., Zawadzki M., Bin Hamri S., Elshazly M., Tan Y.Q., Contreras P.N., Tzelves L., Skolarikos A., Yuen S., Traxer O., Gauhar V. Flexible Ureteroscopy and Laser Lithotripsy Using a Flexible and Navigable Ureteral Access Sheath Are Equally Safe and Effective whether Done in a Sitting or a Standing Position: A Multicenter Study by European Association of Urology-Endourology and the Flexible and Navigable Suction Access Sheath Collaborative Group. Journal of Endourology (2025). doi:10.1177/08927790251364288 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111564
Title
Flexible Ureteroscopy and Laser Lithotripsy Using a Flexible and Navigable Ureteral Access Sheath Are Equally Safe and Effective whether Done in a Sitting or a Standing Position: A Multicenter Study by European Association of Urology-Endourology and the Flexible and Navigable Suction Access Sheath Collaborative Group
Author's Affiliation
Chinese University of Hong Kong
National and Kapodistrian University of Athens
Universiti Malaya
NUS Yong Loo Lin School of Medicine
Haukeland Universitetssjukehus
Menoufia University
Singapore General Hospital
Hôpital Tenon
University Hospital Southampton NHS Foundation Trust
Tan Tock Seng Hospital
Ramathibodi Hospital
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Hospital Aleman
Military Medical Academy, Sofia
King Fahd General Hospital
Ng Teng Fong General Hospital
European Association of Urology
Specialized Medical Center
St. Anna Hospital
Muliawarman University
National and Kapodistrian University of Athens
Universiti Malaya
NUS Yong Loo Lin School of Medicine
Haukeland Universitetssjukehus
Menoufia University
Singapore General Hospital
Hôpital Tenon
University Hospital Southampton NHS Foundation Trust
Tan Tock Seng Hospital
Ramathibodi Hospital
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Hospital Aleman
Military Medical Academy, Sofia
King Fahd General Hospital
Ng Teng Fong General Hospital
European Association of Urology
Specialized Medical Center
St. Anna Hospital
Muliawarman University
Corresponding Author(s)
Other Contributor(s)
Abstract
Introduction: Flexible ureteroscopy (FURS) using the flexible and navigable suction ureteral access sheath (FANS) is a novel technique for treatment of kidney stones. We aimed to compare outcomes of FURS with FANS in the sitting vs standing position. Patients and Methods: We analyzed adult patients from 21 centers who underwent FURS with FANS, divided according to whether the surgeon operated in a sitting or standing position. Baseline demographics, operative parameters, and 30-day outcomes were compared. Multivariable logistic regression was used to identify potential predictive factors for zero residual fragments (ZRF). Results: There were 457 patients in the sitting group and 247 patients in the standing group. In the sitting group, more patients had the surgical procedure under general anesthesia (p = 0.022). Disposable scopes were preferred in the standing group (p < 0.001). Median lasing and ureteroscopy time were significantly shorter in the siting group, but there was no difference in total surgical time (median 45 vs 46 minutes, p = 0.102). A larger but nonsignificant percentage of grade 1 access sheath insertion injuries were reported in the standing position. Multivariable logistic regression analysis showed that stone volume (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, p = 0.003) and operative time (OR: 0.99, 95% CI 0.99-1.00, p = 0.002) but not surgeon position (OR: 1.04, 95% CI: 0.75-1.44, p = 0.82) were significant predictors of ZRF. Procedural safety was not compromised significantly. Conclusions: FURS with FANS is equally safe and effective in the sitting and standing positions. This study provides the impetus to improve FURS ergonomics, especially with the move toward its use in complex and large stones.