ArticleJournal of clinical medicine2022
Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones.
Article in Journal of clinical medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 3 of them syntheses that pooled it.
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Who cites it
54 citing papers in PubMed, 3 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Stone dust in endourology: a systematic review of its definition, management, and clinical impact.BJU international · 2025Pooled it
- Comparison of suction technique and non-suction technique in retrograde intrarenal stone surgery: a systematic review and meta-analysis.International urology and nephrology · 2025Pooled it
- Pooled it
- Postoperative urinary stone analysis-influence of the hydrogel retrieval method on stone analysis.World journal of urology · 2025Trial
- Global Direct In-scope Suction Study: An EAU-endourology Multicenter Prospective Collaboration (DISS-study).European urology open science · 2026Article
- Article
- Outcomes of 6.3 Fr flexible ureterorenoscopy and laser lithotripsy for paediatric kidney stone disease: a multicentre international study from EAU endourology.World journal of urology · 2026Article
- The effect of prestenting on the success rates of endourological stone surgery in children.World journal of urology · 2026Article
- Real-time monitoring with DISS and FANS systems to assure safe and effective stone treatment: Insights from ex-vivo experimental study from EAU endourology.World journal of urology · 2026Article
- Comparative performance of single-use flexible ureteroscopes with and without direct in-scope suction: a retrospective analysis.Journal of medicine and life · 2026Article
- Is the direct in-scope suction (DISS) the solution for the non-prestenting and sheathless flexible ureteroscopy?International urology and nephrology · 2026Article
- Endoscopic combined intrarenal surgery: From percutaneous nephrolithotomy to the future of stone management.Investigative and clinical urology · 2026Review
- Pressure and sheath settings in a flexible suction ureteral access sheath: in-vitro assessment for retrograde intrarenal surgery.World journal of urology · 2026Article
- Experimental stone clearance with in-scope suction and flexible and navigable suction access sheaths.BJU international · 2026Article
- Direct in-scope suction (DISS) ureteroscopy: techniques, outcomes and future directions.BJU international · 2026Review
- Flexible and navigable suction ureteral access sheath's impact on ureteroscope deflection.World journal of urology · 2026Article
- Optimization of laser, irrigation and suction settings for automated ureteroscopic lithotripsy in impacted stones ex vivo study part II.Scientific reports · 2026Article
- Research progress on treating urinary system stones using ureteroscopy combined With a negative-pressure suction sheath.Frontiers in surgery · 2026Review
- Review
- Head-to-head comparison of novel suction technologies in endourology: suction mini-PCNL versus flexible ureteroscopy using flexible and navigable suction ureteral access sheaths for renal stone management. An EAU-endourology, propensity score-matched analysis of 1372 patients.World journal of urology · 2025Article
Corrections and comments
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Authors and funding
10 authors at 7 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0−28.8) vs. 13.0 (11.8−15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0−100) minutes] as compared to the SUAS group [47.5 (41.5−60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667−1.00) vs. 1.00 (1.00−2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.
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