Optimizing Outcomes in Flexible Ureteroscopy: A Narrative Review of Suction Techniques

Abstract

Objective: The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. Methods: A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we conducted a search on the Twitter platform . Studies including suctions systems in fURS were included. Editorials, letters and studies reporting intervention with semirigid ureteroscopy, PCNL and mPCNL were excluded. Results: A total of 12 studies were included in this review. These studies comprised one in vitro study, one ex vivo study, one experimental study and eight cohort studies. The Pubmed and WoSCC searches identified three suction techniques (Irrigation/Suctioning system with control of pressure, suction ureteral access sheath (sUAS) and direct in scope suction (DISS)), and the Twitter search identified four of them. The overall results showed that suction is an effective and safe technique that improves stone-free rates, reduces operative time and limits complication rates after fURS. Conclusions: The use of suctioning during common endourological procedures has been shown to improve safety and efficacy in several indications. However, randomized controlled trials are needed to confirm this.

Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review

“…Among the suction modalities, the use of UAS with suction exhibited lower complication rates, shorter operative times, and reduced incidences of postoperative fever and SIRS. They can control intrarenal pressure, thereby improving visualization and stone fragment removal without the requirement for retrieval baskets ( 51 ).…”

Flexible Ureteral Access Sheath with suction -– Does it make a difference in Retrograde intrarenal surgery?

“…All of the above factors make suction incorporated small calibre UAS, the need of the hour. Suction techniques in RIRS can be of 3 types -Irrigation/suctioning system with control of pressure, direct in scope suction (DISS) and suction ureteral access sheath (sUAS) [11]. It is shown that suction incorporation improves the stone free rates and reduces the complication rates [11].…”

“…Suction techniques in RIRS can be of 3 types -Irrigation/suctioning system with control of pressure, direct in scope suction (DISS) and suction ureteral access sheath (sUAS) [11]. It is shown that suction incorporation improves the stone free rates and reduces the complication rates [11]. On comparing the results of RIRS done using DISS with those of sUAS, Gauhar et al found that, 33.3% of patients in DISS group required a further RIRS whereas only 3.6% of sUAS group required further intervention [12].…”