Ureterorenoscopy is seeing a bloom of technological advances, one of which is incorporating suction. The objective of this study is to systematically review existing literature regarding suction use in rigid and flexible ureterorenoscopy and perform meta-analysis of studies comparing suction versus no suction ureteroscopy or mini percutaneous nephrolithotomy (PCNL).
A literature search was performed (November 2023) in MEDLINE, Embase and Cochrane CENTRAL. Study protocol was registered at PROSPERO (CRD42023482360). Comparative studies (observational and randomized) were eligible for inclusion if they compared suction versus no suction group and reported at least one primary outcome of interest (stone-free or complication rate).
Sixteen studies (5 randomized and 11 observational), analysing 1086 and 1109 patients in standard and suction groups, respectively, were included. Final stone-free rates (SFRs), overall and infectious complications and length of hospital stay exhibited significant improvement when suction was used. When mini-PCNL was compared with flexible ureterorenoscopy with suction, no differences were found in terms of stone-free and infectious complications rates.
Ureterorenoscopy is a commonly performed endoscopic procedure for urolithiasis treatment, the success of which is defined by SFRs and complication rates. Application of suction via ureteral access sheaths, ureteral catheters or scopes may provide improved SFRs, reduced overall and infectious complication rates, along with a reduction in length of hospital stay. Further randomized studies are needed to validate these findings and standardize indications and protocols.
BJUI compass. 2024 Jul 08*** epublish ***
Lazaros Tzelves, Robert Geraghty, Patrick Juliebø-Jones, Yuhong Yuan, Konstantinos Kapriniotis, Daniele Castellani, Vineet Gauhar, Andreas Skolarikos, Bhaskar Somani
Second Department of Urology, Sismanogleio Hospital National and Kapodistrian University of Athens Athens Greece., Department of Urology, Freeman Hospital Newcastle-upon-Tyne UK., Young Academic Urologists (YAU), Urolithiasis Group European Association of Urology (EAU) Arnhem Netherlands., Department of Medicine London Health Science Centre London Ontario Canada., Department of Urology Whipps cross University Hospital London UK., Urology Division Azienda Ospedaliero-Universitaria delle Marche Ancona Italy., Ng Teng Fong General Hospital (NUHS) Singapore., Department of Urology University of Southampton Southampton UK.