Narrative review examines ureteroscopy with negative-pressure suction sheath for kidney and ureteral stones

Ureteroscopy, which is now one of the primary treatments for kidney and ureteral stones, can suffer from unstable vision due to debris and fluid retention, fragment and dust migration, and temporary increases in intrarenal pressure resulting in infectious complications in vulnerable patients. Negative-pressure suction sheaths were introduced as an aid to ureteroscopy to assist in evacuating debris and turbid irrigant while providing more consistent flow dynamics. These devices are intended to improve both the efficiency of the procedure and the physiological safety of the patients. This review will combine the current research on ureteroscopy using suction sheaths with the integration of device design, irrigation-suction coupling, technical standardization, and clinical outcome data. Stone characteristics, device specifications, irrigation/suction variables, and primary endpoint data including stone-free rates, operative time, residual fragment burden, postoperative pain, ureteral injuries, and infectious complications (fever, SIRS, sepsis) were extracted from all eligible studies. The evidence is presented within a mechanistic to outcome model, where suction-assisted flow improves optical clarity, facilitates fragment evacuation, and reduces pressure surges during high energy lithotripsy. The model also addresses tradeoffs related to mucosal collapse risks, ureteral wall stresses, and the requirement for parameter standardization. Suction-assisted ureteroscopy provides a systems-based approach to improving the safety and efficacy of endoscopic lithotripsy, potentially most beneficially applied to high-dusting cases, contaminated or obstructed collecting systems, and anatomically challenging situations. To facilitate the widespread acceptance of this technology, there should be standardized reporting of intrarenal pressure surrogates, suction variable ranges, and comparison techniques used in conjunction with large-scale multicenter clinical trials, and cost-effectiveness analyses.