We aim to review the evolving paradigm in endourology, where technology has led us to manage small stones with ureteroscopy (URS) and large stones with miniaturized percutaneous nephrolithotomy (mPCNL) techniques. We analyse recent literature, their findings, emerging trends and newer technologies that are helping redefine modern day endourology in pushing these boundaries.
A significant trend is the use of smaller devices to treat larger stones via ureteroscopy, and to treat smaller stones via percutaneous nephrolithotomy (PCNL). Improved laser technologies, smaller single use ureteroscopes and nephroscopes, suction access sheaths, all play a key role in this.The use of suction sheaths and vacuum assisted devices allows to control intrarenal pressure and help in reducing infectious and other complications whilst improving the stone-free rate (SFR). The treatment choice often depends on surgical expertise and available resources, guided by anatomical factors, stone composition and patient-specific considerations.
The management of kidney stone disease has undergone a paradigm shift. While ureteroscopy is being done for larger renal stones, miniaturised PCNL is being done for small stones. This has been driven by a surge in technology, but a tailored and patient-centred approach is needed, and must be helped by guidelines and a multidisciplinary approach.
Current opinion in urology. 2025 Apr 04 [Epub ahead of print]
Maria Florencia Frascheri, Pablo Contreras, Dmitry Enikeev, Arman Tsaturyan, Giorgio Bozzini, Bhaskar K Somani
Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Hospital Aleman, Buenos Aires, Argentina., Department of Urology, Vienna Medical University, Vienna, Austria., Department of Urology, Erebuni Medical Center, Yerevan, Armenia., Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy.