Suction techniques in retrograde intrarenal surgery: recent updates

Background: Obstacles accompanying the increasing use of flexible ureteroscope (FURS), such as increased intrarenal pressure, inability to retrieve stone fragments and affected visibility, resulted in the development of ureteral access sheath (UAS), which is used for maintaining low intrarenal pressure and improving the visibility during FURS. However, stones fragment evacuation remains a major problem to be solved. Consequently, the suction, as a traditional concept, was developed to be employed in retrograde intrarenal surgeries (RIRS) which in turn offers multiple advantages such as facilitating stone fragments and dust removal, thus enhancing visibility, intrarenal temperature reduction by allowing continuous irrigation and intrarenal pressure reduction reducing the risk of infection. Objectives: This review aims to outline the recent updates in suction techniques in RIRS clarifying the advantages and disadvantages of each technique. These techniques include Vacuum assisted standard UAS technique, Flexible and Navigable suction UAS (FANS) technique, pressure-controlled suction system, Laser-Synchronized Suction, Direct in scope suction and Steerable ureteroscopic renal evacuation. Conclusion: Although suction systems were not fully investigated and need further studies to provide evidence-based practice, the recent available studies confirm that different suction techniques are superior to traditional ones regarding higher stone free rates, shorter operative times and lower complication rates.