Current evidence for suction in endourological procedures: comprehensive review of literature

Abstract

Purpose of reviewTo identify the latest advances on the utilization of suctioning devices in the surgical treatment of urinary stones. Recent findingsAdvances are being made to incorporate suction and pressure control capabilities in percutaneous and ureteroscopic lithotripsy. Multiple retrospective studies and few prospective studies have shown that suctioning with minimally invasive percutaneous nephrolithotomy, commonly referred to as Super MiniPerc, can lead to better stone-free rates (SFR) and shorter operative time with lower incidence of infectious complications. Suctioning during retrograde intrarenal surgery (RIRS) has mainly been achieved through suctioning ureteral access sheath. Here as well, the incorporation of suction improved the SFR, but most importantly, reduced the risk of postoperative infectious complications. SummaryTheoretically suction in endourological procedures could facilitate stone debris removal and could reduce intrarenal pressure at the same time allowing for increased irrigation flow potentially decreasing operation time and infectious complications. These claims are supported in contemporary clinical studies, reporting superior SFR and reduced postoperative infectious complications in both percutaneous nephrolithotomy and RIRS.

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

“…As further studies explored the utility of suction ureteral access sheath (SUAS), the utility of suction in endourology found a firm footing, as was reported by Quhal et al [29]. By deploying suction and aspiration, urologists could facilitate stone debris removal, reduce IRP, allow for and potentially decrease the operation time and infectious complications, and improve SFR.…”

“…In terms of procedural safety, the regulation of IRP and the ability to enhance irrigation flow during the procedure help mitigate the risks associated with fluid-pump mechanisms, which may result in mucosal injury within the collecting system and the reabsorption of irrigation fluid containing bacteria and endotoxins caused by pyelovenous backflow [28]. Additionally, thorough cleansing of the pelvocalyceal system from debris and residual fragments appears linked to a reduced incidence of postoperative infectious complications [29]. It may be attributed to decreased reliance on accessory instruments, such as baskets, and manipulation of the scope [30].…”