Direct in-scope suction (DISS) ureteroscopy: techniques, outcomes and future directions
Parth U Patel1, Michael Uy1, Casey Dauw1
1Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
BJU International
|August 5, 2025
Summary
Direct in-scope suction (DISS) ureteroscopy enhances stone clearance and visualization during surgery. This emerging technology shows comparable stone-free rates to standard methods, with ongoing innovations promising further improvements in urological stone treatment.
Area of Science:
- Urology
- Endourology
- Surgical Technology
Background:
- Ureteroscopic stone surgery faces challenges in stone fragment management, visualization, and intrarenal pressure control.
- Traditional ureteroscopy may necessitate ureteric access sheaths (UAS) and can lead to increased risks.
Purpose of the Study:
- To review direct in-scope suction (DISS) ureteroscopy, an emerging technology.
- To evaluate its potential to improve stone clearance, visualization, and intrarenal pressure management during ureteroscopic stone surgery.
Main Methods:
- Narrative literature review.
- Incorporation of clinical experience with DISS ureteroscopy systems.
Main Results:
- DISS ureteroscopes offer single or dual channels for irrigation and suction, with varying application methods (continuous/intermittent).
- Early data suggest DISS provides stone-free rates comparable to standard ureteroscopy without increased major complications, and may reduce UAS need.
- Device performance varies, with trade-offs in scope size, flexibility, suction power, and potential for clogging; larger scopes may have deflection limitations.
Conclusions:
- Direct in-scope suction ureteroscopy is an evolution in endourology, addressing limitations of standard techniques.
- Further high-quality evidence is needed, but ongoing innovation in DISS systems holds promise for complete stone clearance.
Related Concept Videos
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
155
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
155
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
350
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
350
01:24Imaging Studies II: Ultrasonography
54
IntroductionUltrasonography, or renal ultrasound, is a noninvasive medical imaging technique that uses high-frequency sound waves to visualize the kidneys, ureters, bladder, and surrounding tissues.Indications for Urinary System UltrasonographyUrinary system ultrasonography is indicated in various clinical scenarios, such as:Kidney Stones (Urolithiasis): To detect and monitor the size and presence of kidney or urinary tract stones.Hydronephrosis: To assess the dilation of the renal pelvis and...
54
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
119
Voiding Cystourethrography (VCUG) and Cystography are specialized radiographic procedures used to examine the structure and function of the bladder and urethra.Voiding Cystourethrography (VCUG)A Voiding Cystourethrogram (VCUG) is a diagnostic imaging procedure that assesses the anatomy and function of the lower urinary tract. It focuses on the bladder, bladder neck, and urethra, helping detect abnormalities such as vesicoureteral reflux (VUR)—the backward or reverse flow of urine into the...
119
01:25Urinary Tract Calculi VI: Surgical Management
27
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
27
01:28Imaging Studies I: Kidney, Ureter, and Bladder Studies
40
Kidney, Ureter, and Bladder (KUB) StudiesKidney, Ureter, and Bladder (KUB) studies are standard diagnostic imaging procedures used to assess the anatomy of the urinary system. They are commonly utilized for patients experiencing abdominal pain or urinary symptoms. By using a simple X-ray of the abdomen, KUB studies can reveal structural and pathological abnormalities within the kidneys, ureters, and bladder. These studies are particularly valuable in diagnosing kidney stones, urinary...
40