How have flexible and navigable suction ureteral access sheaths changed how you decide between URS vs PCNL for larger stones?

The introduction of suction during ureteroscopy has significantly influenced how we utilize ureteroscopy in the management of larger stones. As our stone team is quite facile with PCNL, we would often perform percutaneous nephrolithotomy for stones 1.5 cm or larger. However, ureteroscopic suction te...

When deciding between URS and PCNL, I take many factors into consideration. Patient-specific variables such as comorbidities, anticoagulation status, anatomy, BMI, and the patient’s preferences after shared decision-making can all shift me in one direction or the other. Stone-specific factors, inclu...

FANS with the Storz device has been a game changer for me taking on larger stones. Takes a few cases to get used to the suction and irrigation systems, visualization is better, stone clearance with dusting stones is better, and case time is shortened considerably.