{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T04:19:16Z","timestamp":1761279556081,"version":"build-2065373602"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Urol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Managing large renal stones with minimally invasive techniques is challenging, particularly in achieving optimal stone clearance. This report highlights the use of Retrograde Intrarenal Surgery (RIRS) combined with Combined Direct In-Scope Suction (DISS), Flexible and Navigable Ureteral Access Sheath (FANS), and thulium laser as an innovative approach to managing a complex staghorn stone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and method<\/jats:title>\n                    <jats:p>A 39-year-old male presented with left flank pain and hematuria for three weeks. Imaging revealed a large staghorn stone in the left kidney (2.8 x 1.5 x 4.3 cm, 1000\u20131200 HU) alongside smaller stones (0.5\u20131 cm) with associated grade II hydronephrosis and suspected ureterovesical junction stricture. RIRS was performed with a thulium laser and DISS and FANS to optimize visualization and enable efficient stone debris removal. Postoperative imaging revealed a single residual fragment (10 x 7 mm), resulting in a stone-free rate of 96.2%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The integration of DISS and FANS in RIRS enhances procedural efficacy by maintaining a clear field of view and facilitating real-time removal of stone fragments. This approach proved to be effective in managing a large renal stone with minimal invasiveness, offering advantages such as reduced operative challenges and improved outcomes. This technique demonstrates the potential for RIRS as a viable alternative in selected scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RIRS combined with DISS and FANS represents a promising method for managing complex renal stones, achieving high stone-free rates with minimal complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fruro.2025.1634754","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T04:14:17Z","timestamp":1761279257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effective management of large renal stones using retrograde intrarenal surgery with combined direct in-scope suction and flexible and navigable ureteral access sheath: a case report"],"prefix":"10.3389","volume":"5","author":[{"given":"Nadhif Faza","family":"Ananda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen Graciana","family":"Setiawan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vindasya","family":"Almeira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faiza Lavina","family":"Meutia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Favian Ariiq","family":"Rahmat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armand","family":"Achmadsyah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur","family":"Rasyid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Widi","family":"Atmoko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ponco","family":"Birowo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.2000.00906.x","article-title":"Management of complex renal stones","volume":"86","author":"Rassweiler","year":"2000","journal-title":"BJU Int"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.3390\/jcm13092493","article-title":"Retrograde intrarenal surgery for lithiasis using suctioning devices: A shift in paradigm","volume":"13","author":"Geavlete","year":"2024","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"5710","DOI":"10.3390\/jcm11195710","article-title":"Advances in laser technology for RIRS","volume":"11","author":"Gauhar","year":"2022","journal-title":"J Clin Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1007\/s00345-024-05275-9","article-title":"Evaluation of the DISS system for RIRS","volume":"42","author":"Nedbal","year":"2024","journal-title":"World J Urol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.10.028","article-title":"The SCARE 2018 statement: updating consensus surgical CAse REport (SCARE) guidelines","volume":"60","author":"Agha","year":"2018","journal-title":"Int J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"102663","DOI":"10.1016\/j.eucr.2024.102663","article-title":"Application of DISS in transplanted kidneys","volume":"53","author":"Kritsing","year":"2024","journal-title":"Urol Case Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5710","DOI":"10.3390\/jcm11195710","article-title":"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","volume":"11","author":"Gauhar","year":"2022","journal-title":"J Clin Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.acuroe.2023.06.001.","article-title":"Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery: Results from a systematic review","volume":"48","author":"Giulioni","year":"2024","journal-title":"Actas Urol Esp (Engl Ed)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"17562872241232275","DOI":"10.1177\/17562872241232275","article-title":"Is suction the future of endourology? Overview from EAU Section of Urolithiasis","volume":"16","author":"Jahrreiss","year":"2024","journal-title":"Ther Adv Urol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-019-02654-5","article-title":"Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium: YAG laser","volume":"38","author":"Traxer","year":"2020","journal-title":"World J Urol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.01.011","article-title":"Thulium fiber laser versus Holmium: Yttrium Aluminum Garnet for lithotripsy: a systematic review and meta-analysis","volume":"85","author":"Uleri","year":"2024","journal-title":"Eur Urol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-025-01775-x","article-title":"Enhanced stone-free rates with suctioning ureteral access sheath vs. traditional sheath in retrograde intrarenal surgery: a systematic review and meta-analysis","volume":"25","author":"Gon\u00e7alves","year":"2025","journal-title":"BMC Urol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1007\/s00345-024-05275-9","article-title":"First clinical evaluation of a flexible digital ureteroscope with direct in scope suctioning system (Pusen DISS 7.5Ch): prospective multicentric feasibility study","volume":"42","author":"Nedbal","year":"2024","journal-title":"World J Urol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2023.05.032","article-title":"A feasibility study on clinical utility, efficacy and limitations of 2 types of flexible and navigable suction ureteral access sheaths in retrograde intrarenal surgery for renal stones","volume":"178","author":"Gauhar","year":"2023","journal-title":"Urology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.euf.2024.05.010","article-title":"Could use of a flexible and navigable suction ureteral access sheath be a potential game- changer in retrograde intrarenal surgery? Outcomes at 30 days from a large, prospective, multicenter, real-world study by the European Association of Urology Urolithiasis Section","volume":"10","author":"Gauhar","year":"2024","journal-title":"Eur Urol Focus"},{"key":"B16","doi-asserted-by":"publisher","first-page":"100250","DOI":"10.1016\/j.urolvj.2023.100250","article-title":"Step- by-step guide to flexible and navigable suction ureteric access sheath (FANS)","volume":"20","author":"Gauhar","year":"2023","journal-title":"Urol Video J"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.2000.00906.x","article-title":"Management of complex renal stones","volume":"86","author":"Rassweiler","year":"2000","journal-title":"BJU Int"},{"key":"B18","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.acuroe.2023.06.001","article-title":"Experimental and clinical applications of suction in retrograde intrarenal surgery: Results from a systematic review","volume":"48","author":"Giulioni","year":"2024","journal-title":"Actas Urol Esp (Engl Ed)"}],"container-title":["Frontiers in Urology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fruro.2025.1634754\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T04:14:18Z","timestamp":1761279258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fruro.2025.1634754\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":18,"alternative-id":["10.3389\/fruro.2025.1634754"],"URL":"https:\/\/doi.org\/10.3389\/fruro.2025.1634754","relation":{},"ISSN":["2673-9828"],"issn-type":[{"type":"electronic","value":"2673-9828"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"article-number":"1634754"}}