New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the “snow globe” effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies.

Transurethral enucleation (TUE) has revolutionized the management of benign prostatic obstruction (BPO), offering a minimally invasive solution with superior efficacy across all prostate sizes. This review explores the advancements in TUE techniques, including Holmium Laser Enucleation of the Prostate (HoLEP), Thulium Laser Enucleation of the Prostate (ThuLEP), and bipolar enucleation, highlighting their clinical benefits, safety profiles, and long-term outcomes. Compared to traditional approaches such as transurethral resection of the prostate (TURP) and open prostatectomy, TUE has been associated with reduced complication rates, shorter recovery times, and durable symptom relief. The manuscript also examines patient-centered considerations, such as quality of life improvements and preservation of sexual function, which contribute to high patient satisfaction. Furthermore, the economic advantages of TUE, driven by reduced retreatment rates and healthcare costs, underscore its value for both patients and healthcare systems. Emerging innovations, including artificial intelligence (AI), promise to further enhance procedural planning, surgical precision, and training pathways. Efforts to expand global access through cost-effective adaptations like bipolar enucleation and targeted training initiatives are paving the way for wider adoption of TUE. With its adaptability, technological advancements, and focus on patient outcomes, TUE is poised to become the global standard of care in BPO management.

Background/Objectives: Adoption of single-use ureteroscopes (SU) and flexible and navigable suction ureteral access sheaths (FANS) have improved flexible ureteroscopy (fURS) efficiency and safety. However, the impact of scope–sheath pairing is less studied. This study aims to compare four scope–sheath configurations using reusable ureteroscopes (RU) and SU with either 11/13Fr or 12/14Fr FANS. Methods: We retrospectively evaluated 184 patients undergoing fURS for kidney solitary stones of 10–25 mm. Patients were manually matched across four groups: RU-11/13FANS, RU-12/14FANS, SU-11/13FANS, and SU-12/14FANS (46 patients in each). The endpoints were 30-day stone-free rate (SFR), operative time, surgeon-reported visibility (image clarity and procedural continuity) and postoperative complications. Results: Operative time was significantly shorter in single-use scope groups (p < 0.001). Visibility scores were highest in SU-12/14FANS and lowest in RU-11/13FANS across all subdomains. SFR was higher in SU groups. SU-11/13FANS had a significantly higher SFR than RU-12/14FANS (p = 0.027). In the reusable group, the use of 12/14Fr FANS was associated with a lower SFR compared to the 11/13Fr configuration. Complication rates were low (8.2% overall) and comparable among groups. Conclusions: Pairing SU with 12/14Fr FANS provided optimal visibility and good stone clearance without increasing complications. In contrast, RU paired with 12/14Fr FANS showed slightly reduced efficacy, possibly due to impaired maneuverability. The scope–sheath interaction influenced outcomes differently across scope types, underlining the importance of their matching in fURS.