Retrograde Intrarenal Surgery for Lithiasis Using Suctioning Devices: A Shift in Paradigm?

Area of Science:

• Urology
• Endourology
• Medical Devices

Background:

• Flexible ureteroscopy is a key procedure for treating kidney stones.
• Improving efficacy and safety, particularly regarding intrarenal pressure and stone fragment removal, remains a focus.
• New suction-enabling technologies aim to address these challenges.

Purpose of the Study:

• To review novel suction endoscopes, ureteral access sheaths (UAS), and catheters designed for flexible ureteroscopy.
• To evaluate their potential benefits in managing intrarenal pressure and stone clearance.
• To discuss the combined use of flexible-tip suction UAS and direct in-scope suction (DISS).

Main Methods:

• Review of new suction technologies for flexible ureteroscopy.
• Discussion of suction ureteral access sheaths (UAS) with non-flexible and flexible tips.
• Description of direct in-scope suction (DISS) and steerable aspiration catheters.
• Evaluation of the Venturi effect for stone fragment removal.

Main Results:

• Suction UAS, especially with non-flexible tips, show promise in maintaining low intrarenal pressure and reducing the "snow globe" effect.
• Flexible-tip suction UAS can be navigated within the pyelocaliceal system for targeted stone fragment removal.
• Direct in-scope suction (DISS) aids in regulating intrarenal pressure and improving visibility by aspirating dust and small fragments.
• Steerable aspiration catheters offer another method for enhancing stone clearance.

Conclusions:

• Suction-enabling technologies like suction UAS and DISS demonstrate an advantage in achieving low intrarenal pressure during flexible ureteroscopy.
• The practical impact of these devices on achieving long-term stone-free status requires further investigation.
• Combining flexible-tip suction UAS with DISS may offer synergistic benefits worth evaluating.