Step-by-step guide to flexible and navigable suction ureteric access sheath (FANS)

Retrograde intrarenal surgery (RIRS) is a well-established treatment option for renal calculi. Stone dusting has drastically improved with the advent of high-power LASERs, but the challenge remains in clearing the fine dust and fragments which may become niduses for future stone recurrence. The aim of this article is to demonstrate the use of the Flexible And Navigable ureteric access Sheath (FANS), a novel invention which improves the aspiration of stone dust and fragments, and assess its safety and outcomes. In this video, Clearpetra 12/14 Fr FANS was used with a TFL LASER for RIRS of the renal pelvic calculus. Data regarding intra-operative outcomes, immediate post-operative (within 24 h) and 3-month stone-free rate (SFR), and post-operative complications, was collected. Retrospective analysis was carried out on 45 patients who underwent RIRS between September 2022 and March 2023 across 3 centres. RIRS was successful in all patients (median operating time=65 min). Immediate CT scan within 24 h showed no evidence of pelvicalyceal injury or perinephric fluid collection. 71.1% (n = 32) had 100% SFR immediately post-operation, and this improved to 93.3% (n = 42) at 3-month follow-up. 11 of these 45 patients have been followed up for 6 months – all have 100% SFR and no complications. 35.6% (n = 16) had transient fever which resolved with antibiotics; none had sepsis. A double J stent was placed in 62.6% (n = 28), while 26.6% (n = 12) had an overnight ureteric catheter only. FANS improves single-session SFR and reduces the need for a ureteric stent or catheter. It is safe with minimal complications, reduces the need for ancillary treatment and post-operative follow-up, therefore resulting in cost savings for the hospital and patient.