Institutional billed-charge patterns and resource utilization in flexible navigable aspiration sheath-assisted and no-access-sheath ureteroscopy: a single-center descriptive cohort study

Abstract Purpose To describe institutional billed-charge patterns and resource utilization in flexible navigable aspiration sheath (FANS)-assisted ureteroscopy and ureteroscopy performed without a ureteral access sheath (NoUAS), recognizing that the two pathways were used in clinically different populations. Methods We retrospectively evaluated 88 ureteroscopy cases performed by a single endourologist from September 2024 through August 2025. Preoperative stone volume was manually derived from computed tomography measurements using an ellipsoid approximation. Continuous variables are reported as median (interquartile range [IQR]) and compared with Wilcoxon rank-sum tests; categorical variables used Fisher exact tests. Because case mix and site of service were markedly imbalanced and numeric operative-time data were incomplete for outpatient cases, comparisons were treated as descriptive rather than as estimates of an independent device effect. Results Thirty-six cases used FANS and 52 used NoUAS. FANS cases had greater median stone volume (553 [IQR 257–1,141] vs 208 [115–463] mm 3 ; p =0.001), more frequent intrarenal involvement (29/35 vs 24/51; p =0.001), longer operative time among cases with numeric data (110 [93–134] vs 70 [55–94] min; p <0.001), and more frequent main hospital treatment (25/36 vs 18/52; p =0.002). Charge data were available for 33 FANS and all 52 NoUAS cases. Median total billed charge was $49,919 [46,088–58,100] and $6,330 [3,162–51,306], respectively ( p =0.003); within-site differences were not statistically significant. Conclusion FANS cases occurred within a more complex, higher-charge care pathway, but the observed differences cannot be attributed to the device itself. These data provide an institutional benchmark for future analyses using clinically comparable cohorts, standardized outcomes, and actual cost data.