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Updated: Jan 16, 2026

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The 'suction concept': everything a flexible ureteroscope should have.

Olivier Traxer1,2, Aideen Madden1,2, Mariela Corrales1,2

  • 1Urology Service, AP-HP, Hopital Tenon, Assistance-Publique Hopitaux de Paris, Sorbonne Universite, Paris, France.

BJU International
|September 26, 2025
PubMed
Summary

The ideal flexible ureteroscope (FU) requires integrated suction, not just as a support tool. This concept enhances fluid management, including irrigation, suction, and pressure control for better endourological outcomes.

Keywords:
anatomyirrigationkidneypressurestonetemperatureureterureteroscopevision

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Area of Science:

  • Urology
  • Endourology
  • Medical Device Innovation

Background:

  • Recent advancements in retrograde intrarenal surgery necessitate re-evaluating innovation goals in flexible ureteroscopy (FU).
  • Novel laser technology and suction techniques are emerging as key areas of focus in endourological innovation.
  • Existing flexible ureteroscopes (FU) and complementary devices may not fully integrate essential suction functionalities.

Purpose of the Study:

  • To define a comprehensive 'suction concept' for flexible ureteroscopes (FU).
  • To assess current endourological technologies against the proposed 'suction concept'.
  • To identify gaps in existing technologies regarding integrated fluid management.

Main Methods:

  • Conducted a literature review of suction and intrarenal pressure devices in ureteroscopy (November 2010 - November 2024) using PubMed and MEDLINE.
  • Developed a 10-stage 'suction concept' for flexible ureteroscopes (FU).
  • Qualitatively analyzed 18 selected articles, product brochures, and presentations, comparing them against the developed concept checklist.

Main Results:

  • The literature search yielded 329 articles, with 18 selected for analysis.
  • Technologies reviewed included suctioning ureteric access sheath (SUAS), flexible and navigable SUAS (FANS), steerable ureteroscopic renal evacuation (SURE), and direct in-scope suction (DISS).
  • Comparison with the 'suction concept' checklist revealed varying degrees of integration of suction functionalities in current devices.

Conclusions:

  • Suction should be integrated into flexible ureteroscopes (FU) as a core system, not merely an accessory.
  • The ideal FU requires anatomical flexibility, ease of access and manipulation, excellent vision, and an integrated energy system.
  • Optimal fluid management in FUs includes irrigation, suction, pressure control, blockage detection, and automatic unblocking.