Thirty-day outcomes of Direct In-Scope Suction (DISS) in real-world practice using magneto, MOSES, and Thulium fiber laser technologies for renal and ureteral stones: an EAU endourology study.

Direct in-scope suction (DISS) ureteroscopy integrates aspiration through the ureteroscope working channel, but the interaction between suction and contemporary laser platforms is incompletely defined. We prospectively compared MOSES high-power holmium: YAG, thulium fiber laser (TFL), and Magneto holmium: YAG during DISS-assisted flexible ureteroscopy across 16 centres in 14 countries. Adults treated between May and December 2025 underwent baseline and 30-day non-contrast computed tomography (NCCT). The primary efficacy endpoint was zero-residual-fragment stone-free status (ZRF-SFS; Grade A) on 30-day NCCT; Grade B denoted a single residual fragment ≤ 2 mm. Among 502 patients, 146 received MOSES, 198 TFL, and 158 Magneto. Median operative time was 60, 44, and 40 min, and ureteroscopy time 49, 36, and 27 min, respectively (both p < 0.001). Working-channel blockage requiring flushing was most frequent with TFL (7.5%, 17.7%, and 1.3%; p < 0.001), while scope malfunction requiring change was most frequent with MOSES (7.5%, 0.5%, and 0.6%; p < 0.001). Grade A ZRF-SFS was similar (71.0%, 71.2%, and 72.2%), whereas Grade A + B stone-free status was 86.2%, 96.0%, and 98.1%. Laser platform was not independently associated with Grade A clearance; increasing stone volume was the only significant predictor of lower clearance (OR 0.63 per 1 cm³ [1000 mm³], 95% CI 0.46-0.86). Thus, complete CT-confirmed clearance was comparable across platforms, while operative and device-related differences should be interpreted as exploratory because laser allocation and perioperative practice were centre-dependent.