Purpose: To evaluate the current literature on suction-assisted ureteroscopy, with a focus on its effectiveness and associated complications.

Methods: A comprehensive literature search of MEDLINE, EMBASE, Scopus, and the Mary Ann Liebert database was conducted up to January 2026. Clinical trials involving adult patients undergoing flexible ureteroscopy (FURS) with suction devices, including ureteral access sheath (SUAS), the flexible navigable ureteral access sheaths (FANS), the steerable ureteroscopic renal evacuation (SURE) methods, and the direct in-scope suction (DISS), were included. Outcomes analyzed included operative time, stone-free rate (SFR), and complications. Due to heterogeneity in study designs and definitions, a narrative synthesis was performed.

Results: 44 studies were included: 11 on SUAS, 23 on FANS, 3 on DISS, 3 on SURE, and 3 comparative studies of suction techniques. Operative time was similar in almost all suction device technologies. Significantly lower operative time was seen in 5 of 34 studies using SUAS/FANS. SFR was higher with SUAS/FANS in 15 studies, particularly when smaller sheaths and Thulium fiber laser (TFL) were used. No significant SFR differences were observed in DISS or SURE studies or between combined suction techniques. Overall, suction devices were associated with low complication rates (mainly Clavien–Dindo I–II) and significantly fewer infectious complications than standard ureteroscopy. High-power Ho:YAG lasers and larger UAS sizes were linked to higher postoperative fever, urosepsis, and ureteral injury.

Conclusions: Suction-assisted ureteroscopy seems safe and effective, with potential improvements of SFR and infectious complications. Optimal outcomes appear to depend on sheath size, laser type, and pressure control.