{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:39:01Z","timestamp":1792471141618,"version":"4.5.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate how to assess the optimal length of flexible and navigable suction ureteral access sheaths (FANS) to be used during flexible ureteroscopy (FURS) for kidney stones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective multicenter study (16 centers, July 2024\u2013January 2025) enrolled 226 adults with normal renal anatomy undergoing FURS with FANS for renal stones. Three preoperative measurements were analyzed: (1)\n                      <jats:italic>Subjective<\/jats:italic>\n                      on X-ray: T12\u2013pubic symphysis, (2)\n                      <jats:italic>Objective<\/jats:italic>\n                      on CT: upper pole\u2013pubic symphysis, and (3)\n                      <jats:italic>Dynamic<\/jats:italic>\n                      ureteral catheter length with retrograde pyelogram (RPG): upper pole\u2013urethral meatus. Sheath length appropriateness (too short\/correct\/too long) was assessed intraoperatively using predefined criteria (complete calyceal access, ergonomics, need for ancillary techniques). Secondary outcomes included 30-day stone-free rates (SFR) and complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sheath length was deemed correct in 63.7%, too short in 9.7%, and too long in 26.5% of cases. For both genders, dynamic measurement of ureteric catheter length from upper pole calyx to 5\u00a0cm beyond the urethral meatus demonstrated the strongest correlation with optimal length (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.7). Gender-specific formulas for optimal FANS length were derived: Male: 0.52 \u00d7 ureteral catheter length\u2009+\u200926\u00a0cm. Female: 1.2 \u00d7 ureteral catheter length\u2009\u2212\u20092.1\u00a0cm. Compensatory techniques for length discrepancies included assistant-held stabilization of FANS (28.3%) and telescoping of penis (3.5%). 96% of sheaths accessed all calyces. The 30-day SFR was 92.5% (Grade A: 79.2% zero fragments; Grade B: 13.3% fragments\u2009\u2264\u20092\u00a0mm). Complications were low: sepsis not requiring ICU admission (0.4%) and ureteric stricture (0.6%). Only 2.7% patients were planned for reintervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The selection of an optimal FANS length is critical for optimizing outcomes in FURS. Dynamic RPG-ureteral catheter length measurement best predicts this, enabling gender-specific formulas for easy estimation. Our results provide valuable insights into the clinical relevance of preoperative measurements, intraoperative adjustments, and the impact of sheath length on procedural success and complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-026-06200-y","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:13:43Z","timestamp":1768839223000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["How do we choose the optimal length of flexible and navigable suction ureteral access sheaths (FANS): an EAU endourology and AUSET prospective multicenter analysis"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-1558","authenticated-orcid":false,"given":"Steffi Kar 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