Background: Retrograde intrarenal surgery (RIRS) is a
cornerstone for managing renal calculi <2 cm, yet it faces limitations
including elevated intrarenal pressure, suboptimal stone clearance, and
infectious complications. The integration of suction, particularly via Flexible
and Navigable Ureteral Access Sheath (FANS), aims to mitigate these challenges.
This chapter provides a critical appraisal of the role of suction in RIRS.
Methods: A synthesis of current literature and technical
principles was conducted to evaluate the mechanisms, clinical outcomes,
advantages, and limitations of FANS-assisted RIRS.
Results: FANS facilitates continuous outflow of irrigation
fluid, stabilising intrarenal pressure and reducing the risk of pyelovenous
backflow and sepsis. It enhances intraoperative visibility and may improve
stone-free rates by actively evacuating fragments. However, these benefits must
be weighed against increased costs, a learning curve, and a currently limited
evidence base from large randomised trials.
Conclusion: Suction-assisted RIRS represents a significant
technical advance, particularly beneficial in cases with enormous stone
burdens, lower-pole stones, or infected systems. The decision to utilise
suction—"to suck or not to suck"—should be individualised, as it is
not a mandatory addition for all RIRS procedures but a valuable adjunct in
select clinical scenarios.
Author(s) Details
Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai, India.
Velmurugan
Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education &Research Chennai, India.
Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai, India.
Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH7
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