{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:07:26Z","timestamp":1793390846485,"version":"4.5.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009391","name":"Kafkas University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009391","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Urolithiasis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This study compares the efficacy and safety of two techniques for flexible ureteroscopy (FURS) in managing 2\u20133\u00a0cm lower pole renal stones: the use of flexible and navigable access sheath (FANS) versus direct in-scope suction (DISS) without an access sheath. A retrospective analysis of 60 patients undergoing FURS for lower pole renal stones was conducted between March 2023 and January 2025. Group 1 (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200932) underwent FANS-assisted procedures, while Group 2 (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200928) underwent sheathless FURS with DISS. Stone-free rates (SFR) were assessed with non-contrast computed tomography (NCCT) after four weeks. Operative time, peri- and postoperative complications, and hospitalization duration were also compared. The mean operative time was significantly shorter in the FANS group (71.8\u2009\u00b1\u200911.5\u00a0min) compared to the DISS group (79.1\u2009\u00b1\u200911.7\u00a0min,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.026). The difference between the SFRs obtained in the FANS group (62.5%) and the DISS group (46.4%) after the first session was not statistically significant (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.162). After the second session, SFRs were also comparable (87.5% vs. 82.1%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.412) (Residual stones\u2009&lt;\u20094\u00a0mm were considered stone-free). Completely stone-free rates (CSFR), defined as the absence of residual fragments after the first session were 43.7% in the FANS group and 32.1% in the DISS group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.256), while after the second session, these rates increased to 84.3% and 75%, respectively (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.280). Postoperative fever rates (9.3% vs. 10.7%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.598) and hospitalization duration (2.5\u2009\u00b1\u20091.3 vs. 2.6\u2009\u00b1\u20091.4 days,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.819) were similar. Both techniques achieved high overall SFRs for large lower pole stones in a staged manner. However, FANS was associated with a shorter operative time. While DISS eliminates the need for an access sheath, its longer operative time may be a limitation. Larger studies are needed to further evaluate these techniques.\n                  <\/jats:p>","DOI":"10.1007\/s00240-025-01748-7","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T10:18:56Z","timestamp":1745057936000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Comparison of flexible ureteroscopic suction techniques: efficacy and safety of flexible and navigable access sheath (FANS) vs. direct in-scope suction (DISS) in the management of 2\u20133\u00a0cm lower pole renal stones"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3065-9001","authenticated-orcid":false,"given":"\u00dcmit","family":"Yildirim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8370-3793","authenticated-orcid":false,"given":"Mehmet","family":"Uslu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4422-6768","authenticated-orcid":false,"given":"Mehmet","family":"Ezer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4205-5455","authenticated-orcid":false,"given":"\u00c7a\u011flayan","family":"Erdo\u011fdu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1944-7059","authenticated-orcid":false,"given":"Ramazan","family":"Kocaaslan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2473-1313","authenticated-orcid":false,"given":"Kemal","family":"Sarica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"1748_CR1","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/J.UROLOGY.2007.09.023","volume":"71","author":"AE Perlmutter","year":"2008","unstructured":"Perlmutter AE, Talug C, Tarry WF et al (2008) Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology 71:214\u2013217. https:\/\/doi.org\/10.1016\/J.UROLOGY.2007.09.023","journal-title":"Urology"},{"key":"1748_CR2","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.3390\/jcm13041114","volume":"13","author":"M Akram","year":"2024","unstructured":"Akram M, Jahrreiss V, Skolarikos A et al (2024) Clinical medicine urological guidelines for kidney stones: overview and comprehensive update. J Clin Med 13:1114. https:\/\/doi.org\/10.3390\/jcm13041114","journal-title":"J Clin Med"},{"key":"1748_CR3","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/S00240-017-1022-X","volume":"46","author":"DA Wollin","year":"2018","unstructured":"Wollin DA, Preminger GM (2018) Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis 46:87\u201397. https:\/\/doi.org\/10.1007\/S00240-017-1022-X","journal-title":"Urolithiasis"},{"key":"1748_CR4","doi-asserted-by":"publisher","unstructured":"Wang DJ, Liang P, Yang TX et al (2024) RIRS with FV-UAS vs. MPCNL for 2-3-cm upper urinary tract stones: a prospective study. Urolithiasis 52. https:\/\/doi.org\/10.1007\/S00240-024-01539-6","DOI":"10.1007\/S00240-024-01539-6"},{"key":"1748_CR5","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/IJU.15347","volume":"31","author":"Y Chen","year":"2024","unstructured":"Chen Y, Xi H, Yu Y et al (2024) Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2\u20133\u00a0cm renal stones. Int J Urol 31:281\u2013286. https:\/\/doi.org\/10.1111\/IJU.15347","journal-title":"Int J Urol"},{"key":"1748_CR6","doi-asserted-by":"publisher","unstructured":"Tsaturyan A, Peteinaris A, Ventimiglia E et al (2025) Aspiration properties of flexible and navigable suction ureteral access sheath (FANS) and flexible ureteroscope with direct-in-scope suction (DISS): an in-vitro experimental study by EAU young academic urologists (YAU) urolithiasis and endourology working group. International Urology and Nephrology 2025 1\u20137. https:\/\/doi.org\/10.1007\/S11255-025-04405-5","DOI":"10.1007\/S11255-025-04405-5"},{"key":"1748_CR7","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.3390\/JCM13092493","volume":"13","author":"P Geavlete","year":"2024","unstructured":"Geavlete P, Multescu R, Mares C et al (2024) Retrograde intrarenal surgery for lithiasis using suctioning devices: A shift in paradigm?? J Clin Med 13:2493. https:\/\/doi.org\/10.3390\/JCM13092493","journal-title":"J Clin Med"},{"key":"1748_CR8","doi-asserted-by":"publisher","unstructured":"Abushamma F, Abu Alwafa R, Zyoud SH (2025) Sheathless RIRS in the era of slim and single use flexible ureteroscopy (ssFURS): prospective analysis of clinical outcome. Urologia 92. https:\/\/doi.org\/10.1177\/03915603241282734","DOI":"10.1177\/03915603241282734"},{"key":"1748_CR9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/MOU.0000000000000030","volume":"24","author":"A Breda","year":"2014","unstructured":"Breda A, Angerri O (2014) Retrograde intrarenal surgery for kidney stones larger than 2.5\u00a0cm. Curr Opin Urol 24:179\u2013183. https:\/\/doi.org\/10.1097\/MOU.0000000000000030","journal-title":"Curr Opin Urol"},{"key":"1748_CR10","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/J.JPEDSURG.2023.10.051","volume":"59","author":"G Collura","year":"2024","unstructured":"Collura G, D\u2019Ippolito G, Lopes Mandes AL et al (2024) Vacuum-assisted Mini-percutaneous nephrolithotomy for 2\u20133-cm renal stones: A comparative study with retrograde Intra-renal surgery. J Pediatr Surg 59:412\u2013415. https:\/\/doi.org\/10.1016\/J.JPEDSURG.2023.10.051","journal-title":"J Pediatr Surg"},{"key":"1748_CR11","doi-asserted-by":"publisher","first-page":"485","DOI":"10.22037\/UJ.V18I07.6443","volume":"18","author":"A Coskun","year":"2021","unstructured":"Coskun A, Eryildirim B, Sarica K et al (2021) Comparison of mini percutaneous nephrolithotomy (Mini PCNL) and retrograde intrarenal surgery (RIRS) for the minimal invasive management of lower caliceal stones. Urol J 18:485\u2013490. https:\/\/doi.org\/10.22037\/UJ.V18I07.6443","journal-title":"Urol J"},{"key":"1748_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/S00423-024-03275-2\/TABLES\/4","volume":"409","author":"L Wang","year":"2024","unstructured":"Wang L, Zhou Z, Gao P et al (2024) Comparison of traditional and suctioning ureteral access sheath during retrograde intrarenal surgery in the treatment of renal calculi. Langenbecks Arch Surg 409:1\u20138. https:\/\/doi.org\/10.1007\/S00423-024-03275-2\/TABLES\/4","journal-title":"Langenbecks Arch Surg"},{"key":"1748_CR13","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1007\/S00345-024-05275-9\/TABLES\/2","volume":"42","author":"C Nedbal","year":"2024","unstructured":"Nedbal C, Yuen SKK, Akram M et al (2024) First clinical evaluation of a flexible digital ureteroscope with direct in scope suctioning system (Pusen DISS 7.5Ch): prospective multicentric feasibility study. World J Urol 42:560. https:\/\/doi.org\/10.1007\/S00345-024-05275-9\/TABLES\/2","journal-title":"World J Urol"},{"key":"1748_CR14","doi-asserted-by":"publisher","first-page":"5710","DOI":"10.3390\/jcm11195710","volume":"2022","author":"J Barratt","year":"2022","unstructured":"Barratt J, Gauhar V, Kumar Somani B et al (2022) Clinical medicine technique, feasibility, utility, limitations, and future perspectives of a new technique of applying direct In-Scope Suction to improve outcomes of retrograde intrarenal surgery for stones. J Clin Med 2022:5710. https:\/\/doi.org\/10.3390\/jcm11195710","journal-title":"J Clin Med"},{"key":"1748_CR15","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/J.JURO.2012.08.197","volume":"189","author":"O Traxer","year":"2013","unstructured":"Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580\u2013584. https:\/\/doi.org\/10.1016\/J.JURO.2012.08.197","journal-title":"J Urol"},{"key":"1748_CR16","doi-asserted-by":"publisher","first-page":"2815","DOI":"10.3390\/jcm12082815","volume":"12","author":"C Solano","year":"2023","unstructured":"Solano C, Chicaud M, Kutchukian S et al (2023) Clinical medicine optimizing outcomes in flexible ureteroscopy: A narrative review of Suction techniques. J Clin Med 2023 12:2815. https:\/\/doi.org\/10.3390\/jcm12082815","journal-title":"J Clin Med 2023"},{"key":"1748_CR17","unstructured":"Thulium fiber laser the new player for kidney stone treatment? A comparison with Holmium:YAG laser - PMC. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7363731\/?utm_source=chatgpt.com. Accessed 26 Feb 2025"},{"key":"1748_CR18","doi-asserted-by":"publisher","first-page":"3345","DOI":"10.1007\/S00345-023-04606-6","volume":"41","author":"A Shrestha","year":"2023","unstructured":"Shrestha A, Adhikari B, Panthier F et al (2023) Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 41:3345\u20133353. https:\/\/doi.org\/10.1007\/S00345-023-04606-6","journal-title":"World J Urol"},{"key":"1748_CR19","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1089\/END.2008.0345","volume":"24","author":"NP Pardalidis","year":"2010","unstructured":"Pardalidis NP, Andriopoulos NA, Sountoulidis P, Kosmaoglou EV (2010) Should percutaneous nephrolithotripsy be considered the primary therapy for lower pole stones? J Endourol 24:219\u2013222. https:\/\/doi.org\/10.1089\/END.2008.0345","journal-title":"J Endourol"},{"key":"1748_CR20","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3978\/J.ISSN.2223-4683.2012.12.01","volume":"1","author":"E Taylor","year":"2012","unstructured":"Taylor E, Miller J, Chi T, Stoller ML (2012) Complications associated with percutaneous nephrolithotomy. Transl Androl Urol 1:223. https:\/\/doi.org\/10.3978\/J.ISSN.2223-4683.2012.12.01","journal-title":"Transl Androl Urol"}],"container-title":["Urolithiasis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00240-025-01748-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00240-025-01748-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00240-025-01748-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T23:02:45Z","timestamp":1766530965000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00240-025-01748-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,19]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1748"],"URL":"https:\/\/doi.org\/10.1007\/s00240-025-01748-7","relation":{},"ISSN":["2194-7236"],"issn-type":[{"value":"2194-7236","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,19]]},"assertion":[{"value":"3 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}