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PubMed · 42381433

F-URS with FANS versus mPCNL for 2-3 cm UUTS: a RCT with a subgroup analysis of 2-2.5 cm stones.

Rui Wang·Xingwang Qi·Chunpeng Li·Junkai Huang·Linguo Xie·Liwei Liu·Haijie Xie·Chunyu Liu
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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&#x2009;cm upper urinary tract stones (UUTS), with a prespecified subgroup analysis for stones &#x2265;2 to <2.5&#x2009;cm. METHODS: This randomized controlled trial enrolled 326 patients with 2-3&#x2009;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 &#x2265;2 to <2.5&#x2009;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&#x2009;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 &#x2265;2 to <2.5&#x2009;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&#x2009;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 &#x2265;2 to <2.5&#x2009;cm subgroup, FANS shows comprehensive benefits over mPCNL. These findings support FANS as an effective alternative to mPCNL for 2-3&#x2009;cm stones and a potentially preferred option for stones measuring 2-2.5&#x2009;cm.

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HumansNephrolithotomy, PercutaneousUreteroscopyFemaleMaleKidney CalculiMiddle AgedUreteral CalculiLength of StayTreatment OutcomeAdultOperative TimeSuctionflexible and navigable suction ureteral access sheathflexible ureteroscopyminimally invasive percutaneous nephrolithotomystone&#x2010;free rateupper urinary tract stonesJournal ArticleRandomized Controlled TrialComparative Study

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Rui Wang, Xingwang Qi, Chunpeng Li, Junkai Huang, Linguo Xie, Liwei Liu, Haijie Xie, Chunyu Liu. 2026-07-01. F-URS with FANS versus mPCNL for 2-3&#x2009;cm UUTS: a RCT with a subgroup analysis of 2-2.5&#x2009;cm stones.. https://doi.org/10.1111/bju.70367

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Journal Article; Randomized Controlled Trial; Comparative Study resourceAdult subjectComparative Study subjectFemale subjectHumans subjectJournal Article subjectKidney Calculi subjectLength of Stay subjectMale subjectMiddle Aged subjectOperative Time subjectRandomized controlled trials study

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