To identify patients’ priority postoperative information needs following urinary stone surgery, we conducted a multicenter cross-sectional survey of patients who underwent surgery for urinary stone disease at eight centers between February 3 and July 1, 2025. Eligible procedures included ureteroscopy with laser lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery. A postoperative questionnaire was completed at a median of 17 days after surgery. Of 381 eligible patients approached, 356 were enrolled, and 332 completed the questionnaire and were included in the analysis (completion rate, 93.3
Advances in laser lithotripsy have driven major progress in endourology over the past three decades. Although Holmium:YAG and, more recently, thulium-based lasers are widely used, the fundamental mechanisms governing laser-to-stone interaction remain incompletely understood and controversial. A systematic literature search was performed in MEDLINE/PubMed and Embase from database inception to December 2025. Experimental and translational studies investigating physical, thermal, chemical, or mechanical mechanisms of laser-to-stone interaction were included. Data on experimental models, laser parameters, environmental conditions, measurement techniques, and mechanistic outcomes were extracted. Methodological quality was assessed using the QUINN scale. Because of the marked heterogeneity in study designs, populations, and outcome measures, a meta-analysis could not be performed. Consequently, the findings were synthesized through a structured narrative systematic review. Twenty experimental studies published until 2025 were included. Early investigations primarily supported photothermal and thermochemical ablation under contact conditions. Contemporary studies employing high-speed imaging, hydrophone measurements, and controlled environmental manipulation consistently demonstrated that non-contact dusting is dominated by cavitation-driven erosion mediated by asymmetric bubble collapse. Recent evidence further identified confined intra-crater bubble expansion as the important mechanism underlying fracture of impacted stones. Mixed thermal and mechanical effects were observed under transitional conditions, particularly in the presence of pulse modulation and optimized energy transmission. Methodological quality improved over time, with the highest rigor observed in recent mechanistic studies. Laser lithotripsy is governed by distinct, strategy-dependent physical mechanisms rather than by a single dominant process. Contact ablation is primarily photothermal, non-contact dusting is cavitation-driven, and impacted stone fracture relies on confined bubble expansion. These findings support an integrated mechanistic framework linking laser settings, fiber positioning, environmental conditions, and stone geometry. This framework provides a rational basis for optimizing clinical strategies and guiding future technological development in laser lithotripsy.
To characterize hydrodynamic outcomes under different irrigation, suction, and ureteroscope conditions during suction-assisted retrograde intrarenal surgery (RIRS) in an ex vivo porcine model.Two single-use flexible ureteroscopes (6.3-Fr and 7.3-Fr, identical 3.6-Fr working channel, same manufacturer) were matched with a 10/12-Fr ureteral access sheath. Independent variables included two irrigation rates (100, 200 mL/min) and three suction levels (0, − 75 mmHg, − 150 mmHg). Primary endpoints covered stone fragment evacuation rate, mean intrarenal pressure (IRP), cumulative duration of IRP > 30 mmHg, depressurization time (RT1/RT2), and collecting-system collapse grade. Each experimental combination was repeated 10 times.Without suction, mean IRP ranged from 56.3 to 79.1 mmHg and the duration of IRP > 30 mmHg exceeded 42.4 s within the 60-s observation period. Both suction magnitudes maintained mean IRP below 30 mmHg and eliminated measurable high-pressure exposure. The highest fragment evacuation rate was achieved with the 6.3-Fr ureteroscope at 200 mL/min irrigation flow and − 150 mmHg suction (2.134 ± 0.896 g/min), exceeding the rate observed with the 7.3-Fr configuration (1.482 ± 0.346 g/min). Active suction accelerated pressure-relief kinetics relative to passive depressurization (RT2 < RT1). Mild collecting-system collapse (Grade 1) occurred exclusively under low inflow (100 mL/min) combined with active suction, indicating that collapse is driven by net fluid balance rather than absolute IRP alone.Within a 10/12-Fr ureteral access sheath, active suction effectively reduced IRP, eliminated high-pressure exposure above 30 mmHg during the 60-s observation period, and accelerated pressure relief. The 6.3-Fr ureteroscope demonstrated a more favourable pressure-clearance profile than the 7.3-Fr ureteroscope under the tested conditions.
