Table 1.

Suction in endourology – rationale, devices, evidence, limitations, and future directions

SUCTION IN ENDOUROLOGY
Rationale	Clearance of stone fragments and debris
	Intrarenal pressure regulation
	Enhanced visualisation and fragment clearance
	Temperature modulation
	Surgical ergonomics and efficiency
	Decrease operative times
Devices and systems	Flexible and navigable suction sheath (FANS)
	PCNL suction sheaths
	Direct in-scope suction (DISS)
	Pressure-controlled irrigation systems
Evidence and outcomes	Improved stone-free rates
	Reduced operative time
	Lower infectious complications
	Better ergonomics
Limitations and controversies	Cost and access
	Learning curve
	Environmental impact
	Evidence gap
Future directions	Standardized metrics
	Artificial intelligence and automation
	Integration into training curricula
	Value-based health care