Small Diameter (7.5 Fr) Single-Use Flexible Ureteroscopy with Direct In-Scope Suction (DISS) in Conjunction with Aspiration-Assisted Flexible Access Sheath: A New Hype for Real Stone-Free?

: Renal lithiasis continues to represent a great challenge for modern urology in terms of minimally invasive management of lithotripsy procedures. The recent revolution of endoscopes with the miniaturization of instruments and the development of improved disposable ureteroscopes combined with recent suction methods such as suction access sheaths or direct in-scope suction (DISS) systems promise to further improve the outcome of renal stone treatment. : Considering this technological advance, this study aims to evaluate the results obtained by combining these methods in three groups: Group 1-Single-use 7.5 Fr flexible ureteroscope with standard access sheath, Group 2-Single-use 7.5 Fr flexible ureteroscope with direct in-scope suction (DISS) with standard access sheath, Group 3-Single-use 7.5 Fr flexible ureteroscope with DISS with suction access sheath. A total number of 105 consecutive patients were enrolled in the study, divided equally in each group. Several parameters were followed, such as size and location of the stones, operative time, duration of hospitalization, the need for ureteral stent insertion, residual fragments, and subjective evaluation of the lithotripsy environment visualization. : The best results were highlighted in Group 3 for almost all evaluated parameters. Significant improvements were indicated in terms of stone-free rates. : Additional large studies are needed to support these initial results, but preliminary data indicate a valuable advantage for every urologist who treats urolithiasis.