The advent of suction technology in retrograde intrarenal surgery (RIRS) promises to overcome commonly encountered issues including poor visibility, residual fragments and elevated intra-renal pressures (IRP) causing infectious complications. This systematic review evaluates the safety profile and efficacy of novel suction devices compared to current practices in the management of renal and upper ureteral stones in the adult population.

A systematic search of the literature was conducted on 21th December 2024 using Embase, Medline and Scopus. Only English papers involving adult populations with typical anatomy were accepted.

Thiry-four articles were deemed suitable for the purposes of this review. Various methods of suction-assisted RIRS have been described, including suction ureteral access sheaths (S-UAS), tip-flexible suction ureteral access sheaths (TFS-UAS), direct in scope suction (DISS) and aspiration catheters, as a means to improve the safety and efficacy of RIRS. Suction devices have shown significant advantages by vacuuming debris to improve visibility and maximise stone clearance, even for larger stones typically managed by percutaneous nephrolithotomy. Improved stone-free rates, shorter operating times, less requirement for basketing and fewer auxiliary surgeries have subsequently been observed. Use of intelligent pressure monitoring has the added benefit of maintaining low IRP intra-operatively, which reduces infectious complications like fever and sepsis. These techniques may offer substantial health economic benefits by reducing operating time, intra-operative costs and hospital stays. However, the lack of high-level evidence limits the standardisation of this technology, currently.

Suction technology in RIRS optimises stone clearance and reduces complication rates by improving visibility for surgeons, evacuating debris and also maintaining low IRP. With further research, it promises to be a useful adjunct to current practices.