The development of kidney stones is currently managed by a less invasive technique that utilizes Retrograde Intrarenal Surgery (RIRS). With RIRS, kidneys can be accessed directly through the urinary bladder without the need for incisions externally. This significantly improves the recovery period. There has been promising improvement in this sector with the introduction of Flexible and Navigable Suction Ureteral Access Sheath (FANS), which aims to improve the efficacy and safety of the traditional RIRS procedure. This paper outlines the difference between FANS-RIRS and traditional RIRS focusing on the operational methodologies, merits, limitations, and clinical results.
Unraveling RIRS
This procedure involves the use of a flexible endoscope known as a ureteroscope that is inserted through the urethra, the bladder, and finally the ureter. During the procedure, urologists can see the interior of the kidney and treat the stones. The stone is usually broken with a laser and the pieces removed or left to pass in urine. RIRS is unlike common techniques such as extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) because it does not use incisions to the skin. This makes the procedure favorable for those with moderate to small sized kidney stones.
Though RIRS is effective, there are still issues with traditional RIRS in relation to the increased internal pressure due to accumulation of irrigation fluid and debris from the stone fragments not being efficient enough.
Introduction to FANS-RIRS
The Flexible And Navigable Suction Ureteral Access Sheath (FANS-RIRS) is considered a major advancement in RIRS technology. This type of sheath has an integrated suction device that allows for fragment and fluid collection during the procedure. The primary aim of FANS is to maximize stone capture, lower intra-renal pressure, and minimize complications such as postoperative infection or renal insult.
The FANS-RIRS does allow for real time evacuation of stone debris aiding in improved visibility in the kidney and thereby enhancing the surgeon’s ability to break and retrieve stones at the same time.
Key Differences Between FANS-RIRS and Traditional RIRS
Below are the key differences between FANS RIRS vs RIRS :-
1. Procedural Stone Fragment Removal Efficiency
Traditional RIRS: Empirical evidence shows that fluid is not usually maintained and that the fragment is left to free float within the kidney. This puts the patient at a risk of needing another surgery to address the fragments.
FANS-RIRS: The stone removal is done with suction for the containing fragment and fluid to improve visibility during the aid of the operation. This dramatically reduces the need for further procedures to remove remaining stones.
2. Intrarenal Pressure Management
Traditional RIRS: Continuous irrigation has been shown to enhance intrarenal pressures which can complicate the postoperative infection and renal harm.
FANS-RIRS: The suction component accounts for a lower intrarenal pressure to be maintained temporally during the procedure by removing copious amounts of fluid, which reduces the potential for complications and increases the safety of the procedure.
3. Procedure Efficiency
Traditional RIRS: Many stone pieces can be removed and efficiency is increased because the stones can continuously be sucked out during the procedure, which allows for less time spent on the operation, less chance of leaving behind stones, and more improvement in effectiveness of the procedure.
The traditional method of removing stones in the kidney with a flexible ureteroscopy involves flushing the ureteral scope with normal saline to remove stone pieces. However, this method increases the duration of the procedure significantly because the fragments that were not completely flushed may require additional procedures to remove the stones.
FANS RIRS : FANS RIRS is a new technique that uses continuous suction for fragment aspiration during flexible ureteroscopy. Several clinical studies have been done to compare the FANS RIRS technique with classical RIRS.
The FANS-RIRS procedure demonstrated a significant difference in stone free rates among children. A multi center study revealed clear differences between FANS RIRS users and patients treated with the conventional method in terms of complications. The study has also shown that FANS reduced secondary procedures and thus proved superior in management of kidney stones.
Potential Drawbacks and Considerations
Even though FANS-RIRS has many benefits, some factors must be thought of prior to the general adoption of this technique.
- Equipment Availability: The adoption and implementation of FANS equipment is currently restricted to select medical centers, which may affect their ability to utilize this technology.
- Learning Curve: Mastery of the FANS-RIRS technique may necessitate training for the surgeons, which may slow down certain procedures for institutions that are in the process of changing to this technique.
- Cost Implications: Addition of advanced suction devices may raise the overall cost of the procedure, which can be a factor for both healthcare providers and patients at the time of treatment selection.
Which Procedure is Right For You?
The decision concerning RIRS or FANS-RIRS use will be made based on many factors such as the patient’s clinical data and the size, localization and composition of the kidney stones.
FANS-RIRS is preferred for:
- Less clearance with larger kidney stones.
- Patients who are vulnerable to infection and have diminished intrarenal pressure.
- Minimizing the requirement of multiple sessions.
Traditional RIRS may be suitable for:
- Patients with less complicated, smaller kidney stones.
- Patients without access to specialized FANS equipment.
- Patients from developing nations along with other cost sensitive regions.
Clinical Outcomes and Studies
As research continues to refine FANS technology, its role in endourology is expected to expand. Potential future developments include:
- Enhanced FANS Design Miniaturization – Design alterations to the FANS for increased efficiency in smaller and even specially designed ureteroscopes.
- Integration with AI – AI powered navigation could make suctioning more efficient enabling less operative time whilst improving surgical accuracy.
- Cost Minimization Strategies – FANS-RIRS would become available to more patients with adopting and developing regions lowering production costs through better technology.
- In FANS-RIRS, the burdens that come with the management of kidney stones are significantly reduced while operational time is cut down, stone clearance and control over intrarenal pressure achieved. However, equipment availability, expense, additional training, and resource access for patients restrict its use.
Expert Kidney Stone Treatment at CureStone
CureStone, located in Gurgaon, is devoted to managing kidney stones for patients across India. It is led by Dr. Deepanshu Gupta, a highly experienced Urologist with specialized training in advanced urological treatments like FANS-RIRS.
Dr. Gupta develops sophisticated procedures tailored to each patient’s needs to improve their chances of getting the best possible results. CureStone ensures a higher standard of care for each patient by incorporating new technologies and methods into practice within a caring and friendly atmosphere.
Schedule an appointment with us today and move towards a life free of discomfort.