, Numan Baydilli 2
, Muhammet İrfan Dönmez 3
, Adree Khondker 4
, Yesica Quirroz Madarriaga 5
, Christa Gernhold 6
, Ugo Maria Pierucci7 7
, Rianne Janna Marie Lammers 8
, Vasileios Tatanis 9
, Beatriz Banuelos Marco 10
, Lisette Aimee t'Hoen 11
2Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
3Department of Urology, Division of Pediatric Urology, İstanbul University, İstanbul Faculty of Medicine, Türkiye
4Department of Surgery, Division of Urology, University of Toronto, Ontario, Canada
5Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
6Department of Pediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria
7Department of Pediatric Surgery, Buzzi Children's Hospital, Milan, Italy
8Department of Pediatric Urology, University Medical Center Groningen, Groningen, Netherlands
9Department of Pediatric Urology, University Hospital of Patras, Patras, Greece
10Department of Urology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
11Department of Pediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
Abstract
Objective: Although new suction/vacuum technologies have been tested in adults in recent years, they remain uncommon in pediatric practice. This systematic review aimed to analyze the existing literature on the effectiveness and safety of new suction technologies for pediatric endourological stone interventions.
Materials and Methods: We conducted a systematic review (PROSPERO CRD420261335417) following the PRISMA 2020 and Cochrane guidelines, searching PubMed, Embase, MEDLINE, Web of Science, and Scopus to identify all published reports on new suction/vacuum technologies for pediatric endourological stone interventions through February 2026. The primary outcomes were intraoperative and postoperative complications and stone-free rates (SFRs). Secondary outcomes included operative time, hospital stay, and the need for ancillary procedures. We used the MINORS tool to assess the risk of bias in nonrandomized cohort studies.
Results: The review included a total of 367 patients (370 renal units) aged 1–17 years who underwent endourological stone surgery. The vacuum-assisted mini-PCNL group had a higher SFR of 81.3–100% and lower complication and reintervention rates of 0–27.8% and 0–12.5%, respectively, compared with conventional mini-PCNL. Furthermore, a higher SFR of 85.7–100% was observed with RIRS using FANS-UAS compared with an SFR of 60–88% in children who underwent conventional RIRS. The former group also had a lower reintervention rate (0–9.5% vs. 0–40%) and fewer grade III–IV complications (0% vs. 8.7%).
Conclusion: Current evidence, although limited and mainly based on observational studies, suggests that suction-assisted technologies may improve stone clearance and maintain acceptable safety profiles in selected pediatric endourological stone interventions. However, the absence of randomized trials, heterogeneous outcome definitions, and limited long-term follow-up prevent definitive conclusions.