The ‘suction concept’: everything a flexible ureteroscope should have

Objective To develop an accurate ‘suction concept’ that should be part of every flexible ureteroscope (FU) and review recent literature on endourology's new technologies to determine if they incorporate all the features of our new concept, as several milestone developments in retrograde intrarenal surgery have led to a re‐framing of innovation goals with recent focus on novel laser technology and suction techniques. Methods A literature review on the main suction (suctioning ureteric access sheath [SUAS] or flexible and navigable SUAS [FANS], steerable ureteroscopic renal evacuation [SURE], and direct in‐scope suction [DISS]) and intrarenal pressure devices during ureteroscopy was conducted from November 2010 until November 2024 using the PubMed and MEDLINE databases. We also develop the ‘suction concept’ using a 10‐stage approach. Results The PubMed and MEDLINE searches returned 329 articles. After duplicate removal and full review of the abstracts and text gathered, 18 full‐text articles, product brochures, and peer‐reviewed abstract presentations were included for qualitative analysis. To better understand the main purpose of the present study, we divided the results into different sections: FANS, DISS, SURE, and single‐use digital FUs with pressure sensor. We compared them to the items checklist that we created to determine if the new FUs or complementary devices fulfil our concept of ‘suction’. Conclusion Suction should be viewed as an integrated system and not as a support tool in endourology. The ideal FU should be anatomically flexible, have easy ureteric access, easy manipulation, excellent vision, an integrated energy system, and the five items included in fluid management, including irrigation, suction, pressure control, blockage detection, and automatic unblocking.