Suction-Assisted Flexible Ureteroscopy for Renal Stone Disease: A Review of Clinical Outcomes

Abstract

Endourological practice has recently shifted toward the integration of active suction–based technologies as a strategy to mitigate the intrinsic drawbacks of standard flexible ureteroscopy (FURS). Elevated intrarenal pressure (IRP) and suboptimal visualization resulting from intrarenal stone dust dispersion, commonly referred to as the “snowstorm” phenomenon, represent major technical challenges and have been implicated in higher rates of postoperative infection and lower stone-free outcomes. This review provides an overview of contemporary evidence supporting suction-assisted retrograde intrarenal surgery (RIRS), highlighting the use of vacuum-enabled ureteral access sheaths, flexible and steerable suction UAS, and newly introduced intraluminal suction systems integrated within the ureteroscope. Current experimental and clinical findings indicate that active suction contributes to regulation of the intrarenal environment by offsetting irrigation flow, maintaining intrarenal pressures below levels associated with pyelovenous reflux, and promoting efficient removal of stone fragments and dust. Such pressure modulation is believed to play a central role in minimizing bacterial migration into the systemic circulation, thereby decreasing the likelihood of postoperative febrile episodes and systemic inflammatory response. Overall, suction-assisted FURS appears to optimize operative workflow, improve stone clearance efficiency, and enhance procedural safety, particularly in patients presenting with complex or high-burden renal calculi.