<span lang="EN-ID">Suction-Enhanced Flexible Ureteroscopy (Flexible and Navigable Suction, Direct In-scope Suction, and Steerable Ureteroscopic Renal Evacuation) Compared with Conventional Non-Suction Techniques: A Systematic Review and Meta-analysis

Introduction: Stone fragmentation during retrograde intrarenal surgery can obscure visualization and raise intrarenal pressure, posing procedural challenges. While various suction-enhanced systems have been developed to mitigate these issues, robust comparative evidence on their performance remains limited. This review synthesizes available evidence on safety and efficacy to guide optimal clinical use. Methods: A PROSPERO-registered systematic review and meta-analysis (CRD۴۲۰۲۵۱۲۳۵۱۸۳) identified comparative adult studies reporting stone-free rate (SFR) and secondary outcomes, such as operative time, complications, and reintervention. Randomized and observational studies were eligible. Data extraction and risk-of-bias assessment were performed independently, and random-effects model with Hartung-Knapp adjustments were applied. Results: Eighteen studies met the inclusion criteria. Flexible and navigable suction (FANS) significantly improved SFR versus traditional ureteral access sheath (T-UAS) (pooled RR ۱.۱۴, ۹۵% CI ۱.۰۸-۱.۲۲) and immediate SFR (RR ۱.۴۶, ۹۵% CI ۱.۱۳-۱.۸۸). Compared with direct in-scope suction (DISS), SFR was comparable, though DISS required longer operative times. One three-arm study found combined DISS+FANS yielded the lowest residual fragments compared with either modality alone. For safety, FANS showed substantially fewer complications than T-UAS (RR ۰.۴۱, ۹۵% CI ۰.۲۷-۰.۶۲), consistent across minor (Clavien-Dindo I-II) and major (III-IV) events. DISS showed numerically higher complication rates than FANS, though without statistical significance. Reintervention outcomes varied across studies, with no consistent superiority of any technique. Conclusion: Suction technologies, particularly FANS, enhanced RIRS efficacy and maintain favorable safety. Emerging modalities such as DISS and SURE show promising outcome, although additional comparative trials are needed to establish their true efficacy and safety.

کلیدواژه ها:

Kidney stone ، Ureteroscopy ، Retrograde Intrarenal Surgery ، Suction Technology