Comparison of suction-evacuation and conventional access sheaths in flexible ureteroscopy for upper tract stone management

Abstract

Flexible ureteroscopy (f-URS) has become a widely accepted and effective minimally invasive approach to the management of upper urinary tract stones because of significant advancements in endourological techniques over the years. Patients with a burden of less than 20 mm in kidney calculi can choose RIRS as their initial surgical treatment, as it has a favourable stone-free rate (SFR) and a lower incidence of intraoperative and postoperative complications, as per the guidelines of the American Urologic Association (AUA) and the European Association of Urology (EAU). Laser lithotripsy, in conjunction with f-URS, has become the standard treatment for renal and upper ureteric stones, particularly in cases where extracorporeal shock wave lithotripsy (ESWL) is ineffective or contraindicated. Procedure allows direct visualization and precise fragmentation of stones; however, the efficiency of stone evacuation remains a major concern. The primary therapeutic methods for renal calculi, in addition to conservative treatment, are ESWL and minimally invasive endoscopic surgical methods, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). The utilization of RIRS for urinary stones has expanded substantially because of advancements in minimally invasive technology and equipment, and the indications have been widely extended. RIRS can enhance surgical vision, reduce intrarenal pressure (IRP), and reduce postoperative infectious complications using a ureteral access sheath (UAS). This review article aimed to compare the feasibility (success of access and easy drainage of fragments) of suction evacuation UAS versus standard UAS during f-URS in upper urinary tract stones lithotripsy.