Search Results (7)

Background and Objectives: Ureteral access sheaths (UASs) are widely used in retrograde intrarenal surgery (RIRS) to facilitate irrigation and instrument access. Recently, flexible and navigable suction UASs (FANS-UASs) have been developed to enhance visibility and stone fragment evacuation; however, their comparative effectiveness remains uncertain. This study aimed to evaluate the clinical outcomes of FANS-UAS versus conventional UAS during RIRS for renal stones. Materials and Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched through May 2025 for comparative studies of FANS-UAS and conventional UAS. Study quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. Primary outcomes included stone-free rate (SFR), operative time, complications, and hospital stay. Subgroup analyses were conducted according to stone size (≤2 cm vs. >2 cm). Results: Nine studies involving 1791 patients were included. FANS-UAS demonstrated a significantly higher SFR (OR = 5.99, 95% CI: 2.86–12.51; I² = 86.7%) and fewer complications (OR = 0.33, 95% CI: 0.23–0.45; I² = 0%). Operative time and hospital stay did not differ significantly between groups. Subgroup analysis showed no significant SFR difference for stones ≤2 cm, whereas for stones >2 cm, FANS-UAS tended to yield higher SFR—though based on limited evidence. Conclusions: FANS-UASs appear to improve stone clearance and reduce perioperative complications in RIRS without increasing operative burden. While further high-quality randomized trials are needed, current evidence supports the growing adoption of FANS-UAS in endourological practice. Full article

Background/Objectives: Adoption of single-use ureteroscopes (SU) and flexible and navigable suction ureteral access sheaths (FANS) have improved flexible ureteroscopy (fURS) efficiency and safety. However, the impact of scope–sheath pairing is less studied. This study aims to compare four scope–sheath configurations using reusable ureteroscopes (RU) and SU with either 11/13Fr or 12/14Fr FANS. Methods: We retrospectively evaluated 184 patients undergoing fURS for kidney solitary stones of 10–25 mm. Patients were manually matched across four groups: RU-11/13FANS, RU-12/14FANS, SU-11/13FANS, and SU-12/14FANS (46 patients in each). The endpoints were 30-day stone-free rate (SFR), operative time, surgeon-reported visibility (image clarity and procedural continuity) and postoperative complications. Results: Operative time was significantly shorter in single-use scope groups (p < 0.001). Visibility scores were highest in SU-12/14FANS and lowest in RU-11/13FANS across all subdomains. SFR was higher in SU groups. SU-11/13FANS had a significantly higher SFR than RU-12/14FANS (p = 0.027). In the reusable group, the use of 12/14Fr FANS was associated with a lower SFR compared to the 11/13Fr configuration. Complication rates were low (8.2% overall) and comparable among groups. Conclusions: Pairing SU with 12/14Fr FANS provided optimal visibility and good stone clearance without increasing complications. In contrast, RU paired with 12/14Fr FANS showed slightly reduced efficacy, possibly due to impaired maneuverability. The scope–sheath interaction influenced outcomes differently across scope types, underlining the importance of their matching in fURS. Full article

Background: Renal lithiasis continues to represent a great challenge for modern urology in terms of minimally invasive management of lithotripsy procedures. The recent revolution of endoscopes with the miniaturization of instruments and the development of improved disposable ureteroscopes combined with recent suction methods such as suction access sheaths or direct in-scope suction (DISS^TM) systems promise to further improve the outcome of renal stone treatment. Methods: Considering this technological advance, this study aims to evaluate the results obtained by combining these methods in three groups: Group 1—Single-use 7.5 Fr flexible ureteroscope with standard access sheath, Group 2—Single-use 7.5 Fr flexible ureteroscope with direct in-scope suction (DISS^TM) with standard access sheath, Group 3—Single-use 7.5 Fr flexible ureteroscope with DISS^TM with suction access sheath. A total number of 105 consecutive patients were enrolled in the study, divided equally in each group. Several parameters were followed, such as size and location of the stones, operative time, duration of hospitalization, the need for ureteral stent insertion, residual fragments, and subjective evaluation of the lithotripsy environment visualization. Results: The best results were highlighted in Group 3 for almost all evaluated parameters. Significant improvements were indicated in terms of stone-free rates. Conclusions: Additional large studies are needed to support these initial results, but preliminary data indicate a valuable advantage for every urologist who treats urolithiasis. Full article

The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS. Full article

New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the “snow globe” effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies. Full article

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. Full article

Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0–28.8) vs. 13.0 (11.8–15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0–100) minutes] as compared to the SUAS group [47.5 (41.5–60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667–1.00) vs. 1.00 (1.00–2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS. Full article