European urology open science · 2026
Global Direct In-scope Suction Study: An EAU-endourology Multicenter Prospective Collaboration (DISS-study).
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Gauhar Vineet, Castellani Daniele, Traxer Olivier, Ragoori Deepak, Fong Khi Yung, Rico Luis, Contreras Pablo, Castillo Christine Joy Garcia, Kwok Jia-Lun, Emiliani Esteban, Ballesta Martinez Begoña, Tsaturyan Arman, Gadzhiev Nariman, Malkhasyan Vigen, Hajj Albert El, Singh Abhishek, Geavlete Petrisor, Geavlete Bogdan, Becker Benedikt, Ying Benjamin Lim Tze, Zawadzki Marek, Pietropaolo Amelia, Herrmann Thomas, Ng Chi-Fai, Somani Bhaskar, Yuen Steffi Kar Kei
Аннотация
BACKGROUND: Direct in-scope suction (DISS) facilitates continuous stone dust evacuation during flexible ureteroscopy (FURS), but prospective evidence validating its clinical efficacy and safety remains limited.
OBJECTIVE: To evaluate the stone-free rates (SFRs), perioperative outcomes, and limitations of DISS during successfully completed FURS for renal and ureteric stones in real-world practice, with the primary outcome being 30-d computed tomography (CT)-determined SFR.
DESIGN SETTING AND PARTICIPANTS: A prospective, multicenter, investigator-led registry was conducted across 16 centers in 14 countries (NCT05297331). Adults undergoing FURS with the Pusen 7.5-Fr DISS scope for any-sized renal/ureteric stones were included.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 30-d postoperative noncontrast CT SFR, classified as grade A (zero residual fragments [ZRF]) and grade B (single ≤2-mm fragment). Multivariable logistic regression identified predictors of ZRF status.
RESULTS AND LIMITATIONS: A total of 540 patients (median age 55 yr; 57% male) were enrolled. Anomalous kidneys were present in 12% (horseshoe 5.0% and malrotation 3.9%). Median stone volume was 590 mm3. Overall SFR (grades A and B) was 93% (501/540; 95% confidence interval [CI] = 90%-95%), with grade A achieved in 71% (386/540). Major complications were rare: no sepsis requiring intensive care unit admission, no transfusions, and only 2.6% ureteral access sheath (UAS)-related injuries (all Traxer grade 1). Postoperative fever >38°C occurred in 6.7% of the patients (36/540). On multivariable analysis for renal stones, stone volume (adjusted odds ratio [OR] 0.56, 95% CI = 0.39-0.79; p = 0.001) predicted lower odds of grade A status, whereas prestenting (adjusted OR 1.32, 95% CI = 0.76-2.33; p = 0.3) and UAS use (adjusted OR 0.76, 95% CI = 0.46-1.26; p = 0.3) were not statistically significantly associated with grade A status.
CONCLUSIONS: Flexible ureteroscopy for kidney and ureteral stones using the 7.5-Fr DISS achieves high SFR with low morbidity in real-world practice. Stone burden remains a key determinant of complete renal stone clearance using DISS.
OBJECTIVE: To evaluate the stone-free rates (SFRs), perioperative outcomes, and limitations of DISS during successfully completed FURS for renal and ureteric stones in real-world practice, with the primary outcome being 30-d computed tomography (CT)-determined SFR.
DESIGN SETTING AND PARTICIPANTS: A prospective, multicenter, investigator-led registry was conducted across 16 centers in 14 countries (NCT05297331). Adults undergoing FURS with the Pusen 7.5-Fr DISS scope for any-sized renal/ureteric stones were included.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 30-d postoperative noncontrast CT SFR, classified as grade A (zero residual fragments [ZRF]) and grade B (single ≤2-mm fragment). Multivariable logistic regression identified predictors of ZRF status.
RESULTS AND LIMITATIONS: A total of 540 patients (median age 55 yr; 57% male) were enrolled. Anomalous kidneys were present in 12% (horseshoe 5.0% and malrotation 3.9%). Median stone volume was 590 mm3. Overall SFR (grades A and B) was 93% (501/540; 95% confidence interval [CI] = 90%-95%), with grade A achieved in 71% (386/540). Major complications were rare: no sepsis requiring intensive care unit admission, no transfusions, and only 2.6% ureteral access sheath (UAS)-related injuries (all Traxer grade 1). Postoperative fever >38°C occurred in 6.7% of the patients (36/540). On multivariable analysis for renal stones, stone volume (adjusted odds ratio [OR] 0.56, 95% CI = 0.39-0.79; p = 0.001) predicted lower odds of grade A status, whereas prestenting (adjusted OR 1.32, 95% CI = 0.76-2.33; p = 0.3) and UAS use (adjusted OR 0.76, 95% CI = 0.46-1.26; p = 0.3) were not statistically significantly associated with grade A status.
CONCLUSIONS: Flexible ureteroscopy for kidney and ureteral stones using the 7.5-Fr DISS achieves high SFR with low morbidity in real-world practice. Stone burden remains a key determinant of complete renal stone clearance using DISS.