# 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.

## Key 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.