Flexible and Navigable Suction Ureteral Access Sheath for Ureteral Stones: A Novel “Çapa” Surgical Technique

TL;DR

A new surgical technique using a flexible suction sheath successfully removes ureteral stones with minimal complications.

Contribution

The first demonstration of a novel FANS UAS technique for ureteral stone treatment.

Findings

FANS UAS enabled efficient stone clearance with no mucosal injury in a clinical case.

The procedure was completed successfully within 90 minutes without complications.

Postoperative imaging confirmed a stone-free status in the patient.

Abstract

The flexible and navigable suction (FANS) ureteral access sheath (UAS) is an optimal innovation for retrograde intrarenal surgery (RIRS), proven to increase stone-free rates while reducing complications and the need for reintervention.1 This novel study aims to be the first to demonstrate the efficacy and reliability of FANS UAS in the treatment of ureteral stones.

A 61-year-old male patient presented with left flank pain. A non-contrast computed tomography (CT) scan revealed 4 stones of 9, 8, 6, and 6 mm in the distal ureter. A JJ stent was placed as part of initial management. One month later, the patient underwent ureteroscopy with FANS UAS to manage the ureteral stones.

The operation was successfully completed within 90 minutes. Ureteroscopy was performed using a 9.8 Fr single-use Redpine flexible ureteroscope, which was advanced through an 11/13 Fr, 40 cm FANS UAS. During laser lithotripsy, stone fragments were efficiently aspirated into the FANS UAS, thereby minimizing mucosal trauma. The Post-ureteroscopy lesion scale (PULS) score was recorded as 0.2 Following complete stone removal, a 6 Fr JJ stent was placed, and the procedure was completed without complications. A non-contrast CT scan obtained 24 hours postoperatively confirmed a stone-free status. The JJ stent was removed one week later.

The use of FANS UAS in ureteral stone management proved to be safe and effective, facilitating efficient stone clearance without mucosal injury. This novel technique offers a promising adjunct to standard ureteroscopy, particularly in cases requiring precise fragmentation control and low complication risk.

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Data Availability Statement:

The data that support the findings of this study are available on request from the corresponding author.

Artificial Intelligence Usage Statement: The authors declared that no Artificial Intelligence Tool was used in the preparation of the manuscript.Ethics Committee Approval: Ethical approval was not required for this study as it is a single case report. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.Informed Consent: Verbal and written informed consent was obtained from the patient who agreed to take part in the study.Peer-review: Externally peer-reviewed.Author Contributions: Concept – R.B.E., T.T.; Design – R.B.E., M.F.Ö.; Supervision – T.T., V.G.; Resources – V.G., S.K.K.Y., O.T.; Materials – R.B.E., M.F.Ö.; Data Collection and/or Processing – R.B.E., M.F.Ö.; Analysis and/or Interpretation – R.B.E., V.G.; Literature Search – R.B.E., M.F.Ö.; Writing – R.B.E.; Critical Review – T.T., V.G., S.K.K.Y., O.T.Declaration of Interests: The authors have no conflicts of interest to declare.Video 1: https://www.youtube.com/watch?v=-L8rG_MVFP4