Integrated suction in flexible ureteroscopy represents a major leap in modern endourology. Specifically, direct in-scope suction (DISS) allows surgeons to actively remove fragments while maintaining stable intrarenal pressure. Consequently, a systematic review by the YAU and EAU sections confirms that this technology improves safety and efficiency. Therefore, it is becoming a useful tool for managing both renal and ureteral stones.

Clinical Impact of Direct In-Scope Suction

Moreover, research shows that direct in-scope suction significantly improves stone-free rates (SFR). In fact, these rates ranged from 39.5% to 100% in various studies. By using suction, clinicians can effectively evacuate fine dust and larger residual fragments. Furthermore, the technology aids in stone relocation and helps reduce intrarenal pressure. This reduction is vital because high pressure often leads to postoperative complications like sepsis.

Safety and Comparative Performance

Additionally, the safety profile of DISS scopes is impressive. While intraoperative complication rates varied, major complications (Grade III-IV) remained very low, under 4.5%. In addition, experimental models demonstrate that DISS scopes perform more efficiently than conventional devices. Thus, this innovation offers a feasible and safer approach for modern stone management compared to traditional methods.

FAQs

How does direct in-scope suction improve stone clearance?

DISS integrates a suction channel into the ureteroscope, allowing for the immediate removal of stone dust and small fragments during laser lithotripsy. This improves visibility and ensures fewer remnants remain in the kidney.

What are the primary safety benefits of using DISS?

The primary benefit is the regulation of intrarenal pressure. By actively aspirating irrigation fluid, the system prevents pressure spikes that could cause infection or renal injury.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.

References

1. Spinos T et al. Flexible ureteroscopy with integrated suction, a useful innovation: a systematic review by the YAU and EAU endourology sections. Curr Opin Urol. 2026 Apr 06. doi: 10.1097/MOU.0000000000001396. PMID: 41936127.


2. Tzelves L, et al. Suction use in ureterorenoscopy: A systematic review and meta-analysis of comparative studies. BJUI Compass. 2024;5(10):945-956.


3. Rico L, et al. Is the direct in-scope suction (DISS) the solution for the non-prestenting and sheathless flexible ureteroscopy? Int Urol Nephrol. 2026.