Agra (Uttar Pradesh) [India], August 18: Kidney stone treatment has quietly gone through one of its biggest shifts in years, and most patients have no idea it’s happening. A newer technique called FANS, short for Flexible and Navigable Suction Ureteral Access Sheath, is helping doctors clear stones more completely and with fewer complications, all without a single external cut.
For decades, the standard for many kidney stones was either shock wave therapy, which doesn’t always fully clear larger stones, or more invasive procedures that involve making an incision into the kidney. Retrograde Intrarenal Surgery, known as RIRS, changed that by allowing doctors to reach the kidney through the body’s natural pathways using a thin scope passed through the urinary tract. What FANS adds to this is suction. As the doctor breaks up a stone, the device continuously pulls out fragments and fluid in real time, instead of them building up inside the kidney during the procedure.
Dr. Manav Agarwal, a Urologist at Nephro Urology Center in Agra with more than 18,000 surgeries to his name, has been following the technique closely as it gains ground internationally.
“The biggest problem with traditional RIRS was always pressure inside the kidney and stone fragments getting left behind,” he said. “Suction changes both of those. You get a clearer view while you’re operating, and you’re removing debris as you go instead of dealing with it afterward.”
Why the suction matters
During RIRS, fluid is used to keep the surgical field visible, and that fluid has to go somewhere. Traditional access sheaths were rigid and often couldn’t reach the lower part of the kidney, one of the harder areas to treat. Newer sheaths with a flexible tip and built-in suction solve two problems at once: they can navigate into tighter spaces, and they actively draw out fluid and stone fragments instead of letting pressure build up inside the kidney.
That pressure buildup isn’t just a technical detail. Higher intrarenal pressure during surgery has been linked to a greater risk of infection and, in some cases, sepsis. Clinical studies comparing suction-assisted RIRS to conventional sheaths have found lower complication rates alongside higher rates of complete stone clearance, meaning fewer patients need a second procedure to deal with leftover fragments.
“Stone-free rate is what patients actually care about, even if they don’t use that term,” Dr. Manav Agarwal said. “Nobody wants to go through a procedure and then find out three months later they still have a piece of stone sitting in the kidney. Suction technology has made a real difference in getting it all out in one sitting.”
Combined with smaller scopes
The suction technique is often paired with newer, thinner ureteroscopes, some as small as 6.3 Fr in diameter, roughly the width of a large pencil lead. A smaller scope can mean less trauma to the ureter during the procedure and, for some patients, less need for a pre-placed stent before surgery. Together with suction, this combination is part of a broader move toward RIRS procedures that are gentler on the body while still clearing stones effectively.
None of this means every patient is a candidate for the newest equipment. Stone size, location, and a patient’s overall anatomy still guide which approach makes sense, and that decision is made case by case after imaging and evaluation.
What this means for patients
Most patients considering kidney stone treatment still assume their only options are waiting it out, shock wave therapy, or a more invasive surgery with a longer recovery. RIRS with modern suction technology adds another option in between, an outpatient or short-stay procedure with no external incision and a quicker return to normal activity for many patients.
Anyone experiencing recurring flank pain, blood in the urine, or a known stone that hasn’t passed on its own is encouraged to get evaluated rather than wait. Diagnosis typically starts with basic imaging, and treatment planning depends on the size and position of the stone. Patients in Agra can learn more about evaluation and treatment options for kidney stones through the Nephro Urology Center.
About Dr. Manav Agarwal
Dr. Manav Agarwal, MCh Urologist, practices at the Nephro Urology Center in Agra and has performed more than 18,000 surgeries covering kidney stone treatment, prostate surgery, reconstructive urology, and uro-oncology.
Media Contact: Nephro Urology Center, Noori Gate Rd, Raja Mandi, Agra 282002, Uttar Pradesh
Phone: 7078911911
Email: nephrourologycenter@gmail.com
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