Frangopoulos Eve, Savin Ziv, Clayman Ralph V, Durbhakula Vinay, Atallah William M, Ali Aymon, Landman Jamie, Gupta Mantu
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Urology, University of California, Irvine, California, USA.
J Endourol. 2025 Aug;39(8):829-840. doi: 10.1177/08927790251364285. Epub 2025 Aug 6.
Endoscopic innovation has played a pivotal role in advancing retrograde intrarenal surgery (RIRS). Integration of aspiration technology into flexible ureteroscopes (fURS), termed direct in-scope suction (DISS), and into ureteral access sheaths (s-UAS) are the most recent and rapidly progressing advancements. Aspiration technologies aim to augment stone-free rates (SFR) associated with traditional RIRS and may provide an alternative to retrograde management of large calculi typically managed with percutaneous nephrolithotomy (PCNL). This systematic and narrative review aims to consolidate the current evidence on aspiration devices used in RIRS. Using the Covidence platform, a literature search was conducted including the PubMed and Web of Science databases from inception to October 2024. This systematic review was registered in PROSPERO (CRD42024613059). Studies were categorized based on level of evidence and included randomized controlled trials (RCTs), comparative observational studies, and large-scale prospective studies; papers were excluded due to expired technology or absence of a traditional fURS comparator group. Literature search yielded 232 articles. Following exclusion and manual review, 11 studies (1 RCT, 8 comparative cohort studies, and 2 large-scale observational studies) were selected for analysis. Assessing level 1 evidence, immediate and final SFRs were significantly higher in s-UAS groups. S-UAS was also superior to traditional fURS in achieving superior SFR for the management of renal calculi with level 3 evidence. Early studies utilizing contemporary aspiration technologies demonstrated superior efficacy and efficiency with respect to immediate SFR and operative times in patients undergoing fURS for renal stones between 1 and 2 cm compared with traditional fURS. Future studies adhering to standardized SFR criteria with postoperative thin-slice (2 mm) noncontrast computed tomography scanning is warranted to more precisely assess the effectiveness of aspiration technology-associated SFR values.
内镜创新在推进逆行性肾内手术（RIRS）方面发挥了关键作用。将抽吸技术集成到软性输尿管镜（fURS）中，即所谓的直视下内镜吸引（DISS），以及集成到输尿管通路鞘（s-UAS）中，是最新且进展迅速的技术进步。抽吸技术旨在提高与传统RIRS相关的无石率（SFR），并可能为通常采用经皮肾镜取石术（PCNL）治疗的大结石的逆行处理提供一种替代方法。本系统综述和叙述性综述旨在整合目前关于RIRS中使用的抽吸装置的证据。利用Covidence平台，进行了文献检索，包括从数据库创建到2024年10月的PubMed和Web of Science数据库。本系统综述已在PROSPERO（CRD42024613059）中注册。研究根据证据水平进行分类，包括随机对照试验（RCT）、比较观察性研究和大规模前瞻性研究；由于技术过时或缺乏传统fURS比较组，相关论文被排除。文献检索共获得232篇文章。经过排除和人工审核，选择了11项研究（1项RCT、8项比较队列研究和2项大规模观察性研究）进行分析。评估一级证据时，s-UAS组的即时和最终SFR显著更高。在处理肾结石方面，s-UAS在实现更高SFR方面也优于传统fURS，具有三级证据。早期利用当代抽吸技术的研究表明，与传统fURS相比，在接受fURS治疗1至2厘米肾结石的患者中，即时SFR和手术时间方面具有更高的疗效和效率。未来有必要采用标准化的SFR标准并进行术后薄层（2毫米）非增强计算机断层扫描，以更精确地评估抽吸技术相关SFR值的有效性。
