The concept of suction has revolutionized the modern endourology. Direct in-scope suction (DISS) allows for simultaneous or alternating suction and aspiration during the endoscopic laser lithotripsy, using the scope as a conduit to aspirate fine dust or fragments from all the renal calyxes.
This study aimed to evaluate the feasibility, safety, and effectiveness of DISS in non-prestented and sheathless flexible ureteroscopy.
A retrospective study was conducted of consecutive patients undergoing DISS at the Hospital Aleman of Buenos Aires between March 2025 and September 2025. We included patients with non-complex kidney stones and those in whom a suction ureteral access sheath was not used and who did not have a ureteral stent before the procedure. A 7.5Fr disposable flexible scope (PU3033AH) was used. Stone-free rate (SFR) was defined according to a 4-week postoperative low-dose non-contrast computed tomography scan as Grade A = absence of stone fragments, Grade B = stone fragments < = 2 mm, and Grade C = stone fragments > 2 mm. Postoperative complications were evaluated according to the Clavien-Dindo classification.
In all, 81 patients were included. The mean stone volume was 582 mm3 (353-858). Thulium Fiber Laser was used in 79.0% and Magneto-Ho:YAG pulse modality in the remaining 21.0%. Total operative time was 40 min (35-45 min) and a postoperative double-J stent was placed in 84.3%. The Grade A SFR was 86.4% and Grade B 13.6% with no patients in Grade C definition. The overall postoperative complications rate (Clavien-Dindo ≤ 2) was 8.6% with no major complications.
DISS without the use of a ureteral access sheath and no preoperative double-J stent placement is effective and safe in selected patients. Further clinical trials are needed to reaffirm the results obtained in this initial experience.
International urology and nephrology. 2026 Jan 09 [Epub ahead of print]
Luis Rico, Lorena Banda Ramos, Juliana Álvarez Jaramillo, Leandro Blas, Pablo Contreras
Department of Urology, Hospital Aleman, Buenos Aires, Argentina. ., Department of Urology, Hospital Aleman, Buenos Aires, Argentina.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41511679