To compare the stone ablation volume (AV) achieved by thulium fiber laser (TFL) and high-power Holmium: YAG (Ho: YAG) lasers with MOSES™, Virtual Basket™ (VB™), Vapor Tunnel™ (VT™), and Magneto pulse-modulation technologies in an artificial stone model. BegoStone phantoms (15:6 “powder-to-water” ratio) were used. A motorized arm applied the laser at a constant speed (0.7 mm/s). Laser settings included 1.5 J × 5 Hz, 1 J × 20 Hz, and 0.3 J × 50 Hz, with five 21-mm cuts per setting. AV was calculated from width and depth measurements using an optical microscope. ANOVA was performed. Among 750 measurements, TFL-200 μm achieved the highest AV in most settings. At 1.5 J x 5 Hz, TFL-200 μm (15.9 mm³) significantly outperformed MOSES™ (LP: 11 mm³, SP: 10.4 mm³, MD: 9.7 mm³) and Magneto (9.1 mm³) (p < 0.05). At 1 J × 20 Hz, TFL-200 μm (21.2 mm³) exceeded all technologies (p < 0.001). At 0.3 J x 50 Hz, TFL-200 μm (8.9 mm³) outperformed MOSES™ MD (3.8 mm³) and Magneto (4.9 mm³), p < 0.05. TFL-150 μm showed comparable AV to Ho: YAG lasers across settings, except at 1 J x 20 Hz, where it was lower than TFL-200 μm and CyberHo150 SP and VT™ (p < 0.05), primarily due to lower depth of fissure (DOF) while width of fissure (WOF) remained comparable. At 0.3 J × 50 Hz, TFL-150 μm (6.7 mm³) demonstrated lower AV than CyberHo150 SP (10.9 mm³; p = 0.003), but higher AV than MOSES™ MD (3.8 mm³; p = 0.034). TFL-200 μm achieved higher AV than Ho: YAG in most settings, but statistical significance was observed in one-third of comparisons. TFL-150 μm demonstrated similar AV to Ho: YAG, except in cases where Ho: YAG had higher DOF. TFL-150 μm has known advantages in terms of irrigation, visibility, ureteroscope tip deflection, and potential for miniaturization of flexible ureteroscopy devices and aspiration methods, supporting its potential applicability for dusting strategies while maintaining comparable AV.

OBJECTIVE:To compare stone ablation volume (AV) and ablation morphology between pulsed thulium:YAG (p-Tm:YAG) and high-power holmium:YAG (Ho:YAG) lasers with different pulse modulation technologies using an in vitro stone model. MATERIALS AND METHODS:BegoStone phantoms (15:6 powder-to-water ratio) were used. A motorized arm applied the laser on the phantoms at a constant speed (0.7 mm/s). Three laser settings were tested: 1.5 J × 5 Hz, 1 J × 20 Hz, and 0.3 J × 50 Hz. For p-Tm:YAG, short pulse (SP) and long pulse (LP) modes were evaluated; for Ho:YAG, SP, LP, Vapor Tunnel™ (VT™), and Virtual Basket™ (VB™) modes were tested. Five 21-mm fissures were created per setting. AV was calculated from fissure width (WOF) and depth (DOF) measured by optical microscopy. RESULTS:A total of 555 measurements were analyzed. At 1.5 J × 5 Hz, p-Tm:YAG (SP) produced the deepest fissures (DOF = 1000 µm vs 523.3-734.3 µm, p < 0.05) and was the only modality with a width-to-depth ratio <1, indicating deeper and narrower fissures. In contrast, p-Tm:YAG (LP) showed DOF and width-to-depth ratios comparable with Ho:YAG. At 1 J × 20 Hz, p-Tm:YAG (LP) generated wider, shallower fissures with a lower AV (11.9 mm³ vs 16.9-19.7 mm³, p < 0.05), whereas Ho:YAG (VB™) demonstrated a comparable AV. At 0.3 J × 50 Hz, p-Tm:YAG (LP) and Ho:YAG (VB™) exhibited similar width-to-depth ratios (1.3-1.4), whereas Ho:YAG (LP) and (VT™) achieved greater AV (7.4-8.0 vs 3.4 mm³; p < 0.05), driven by greater DOF. CONCLUSIONS:p-Tm:YAG and Ho:YAG lasers demonstrated distinct ablation morphologies depending on pulse modulation and laser settings. At intermediate and low-energy settings, p-Tm:YAG (LP) produced wider, shallower fissures, whereas several Ho:YAG modalities achieved greater AV through deeper fissures. Ho:YAG (VB™) showed the most similar ablation morphology to p-Tm:YAG (LP). Whether these differences translate into clinical performance remains to be determined.

The role of ureteral access sheath (UAS) during flexible ureteroscopy (fURS) remains undecided in the era of direct in-scope suction (DISS), which subserves dust and debris removal with active intrarenal pressure control. This study aims to evaluate the utility of UAS on perioperative outcomes in patients undergoing DISS-assisted fURS. This prospective, multicentre study analysed data from an international registry of patients who underwent successful fURS with DISS at 16 centres across 14 countries between May and December 2025. Patients were grouped based on whether UAS was used. All participants had one non-contrast CT scans (NCCT) before and at 30 days post operatively. 100

Background and ObjectiveStudies from the United States and Europe have documented an association between urolithiasis and metabolic and cardiovascular disorders; however, evidence from Latin America remains absent. This study estimated the nationwide prevalence of kidney stone disease in Colombia and assessed its co-occurrence with cardio-reno-metabolic comorbidities and major cardiovascular events.MethodsWe conducted a nationwide descriptive cross-sectional study using the Individual Health Service Provision Records (RIPS) registry (2010-2024). Urolithiasis was identified through ICD-10 codes. Healthcare-based prevalence was stratified by sex and age, and prevalence ratios (PRs) with 95% confidence intervals were calculated comparing individuals with versus without urolithiasis.Results and LimitationsAmong 65.4 million healthcare records, 1,838,661 (2.8%) included a diagnosis of urolithiasis, with slightly higher prevalence in men (2.9% vs. 2.6%). Cardio-reno-metabolic conditions were significantly more frequent among stone formers: hypertension (6.6% vs. 2.2%; PR approximate to 3.0), dyslipidemia (7.3% vs. 2.5%; PR approximate to 2.9), obesity (6.3% vs. 2.6%; PR approximate to 2.5), and diabetes mellitus (7.3% vs. 2.6%; PR approximate to 2.8). Major cardiovascular events were also more prevalent, including ischemic heart disease (7.4% vs. 2.7%; PR approximate to 2.7) and stroke (5.5% vs. 2.8%; PR approximate to 2.0). Chronic kidney disease (CKD) showed the greatest disparity (8.9% vs. 2.7%; PR approximate to 3.3), with particularly pronounced associations in pediatric populations (PR 18.76 in children aged 0-9 years; PR 10.76 in adolescents). The cross-sectional design precludes causal inference.ConclusionsIn this nationwide analysis, kidney stone disease is consistently associated with cardio-reno-metabolic comorbidities, supporting its integration within a broader cardiorenal-metabolic framework. The magnitude and consistency of these associations underscore the need for systematic cardiometabolic screening, renal function monitoring, and lifestyle counseling in stone formers. Longitudinal studies are warranted to establish causality and guide preventive strategies.

OBJECTIVES:To evaluate in vitro determinants of intrarenal temperature (IRT) and pressure (IRP) during laser lithotripsy. MATERIALS AND METHODS:A silicone urinary tract model was used to perform laser lithotripsy on artificial stones placed in the renal pelvis. Three laser sources (thulium fibre laser, holmium:yttrium-aluminium-garnet [Ho:YAG] with Magneto Technology, and pulsed thulium:YAG) with 200-μm fibres were tested at four energy settings (0.6 J-10 Hz, 1 J-10 Hz, 0.2 J-50 Hz, and 1 J-40 Hz), delivering 2000 J per experiment. Irrigation was provided by gravity (40 cmH2O) or hand-pump irrigation, combined with a standard ureteral access sheath (sUAS) or flexible and navigable suction sheath (FANS). Multivariable regression identified predictors of mean IRT and IRP. RESULTS:Baseline temperatures were comparable among groups (27.2-32.2 °C, P > 0.05). Hand-pump irrigation reduced mean IRT compared to gravity (-9.1 °C, P = 0.001). Laser power showed a dose-response effect (10 W: +2.5 °C, P = 0.003; 40 W: +8.2 °C, P = 0.001 vs 6 W). At equivalent power and irrigation settings, laser source did not influence IRT under the experimental conditions evaluated. The thermal-risk threshold (>43 °C) was reached in 16.7% of experiments, increased with power (2.8%, 15.3%, and 41.7% at 6, 10, and 40 W; P = 0.001) and decreased with hand-pump irrigation and FANS (P < 0.05). Hand-pump irrigation increased IRP by 21 cmH2O compared to gravity, while FANS reduced IRP by 12 cmH2O vs sUAS (P = 0.001). CONCLUSIONS:Mean IRT was associated with laser power and irrigation strategy. High-power settings (40 W) frequently exceeded the thermal-risk threshold. Although FANS was not associated with lower mean IRT, it reduced the likelihood of exceeding the thermal-risk threshold. Laser source had no effect on mean IRT when power and irrigation conditions were comparable. Mean IRP was influenced by irrigation strategy and UAS configuration but was not associated with mean IRT. These findings underscore the need for advanced integrated irrigation-aspiration systems capable of dynamic control of flow, pressure, and temperature to optimise procedural safety.

OBJECTIVE:To systematically review and meta-analyse the available evidence comparing perioperative outcomes between small- (≤6.3/7.5 F) and large-calibre (≥7.5/9.8 F) ureteroscopes. METHODS:A literature search of MEDLINE/PubMed, and Scopus was performed prior to March 2026 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The endpoints of interest were stone-free rates (SFRs), overall complications, and operative time. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale and the Revised Cochrane Risk of Bias Tool for Randomised Trials for non-randomised and randomised studies. Sensitivity analyses were completed on studies reporting flexible ureteroscopes only, 7.5- vs >7.5-F ureteroscopes, and on randomised controlled trials (RCTs). RESULTS:Eight studies were included in the meta-analysis. Of those, four were RCTs while four were retrospective. Specifically, three studies compared 6.3- vs 7.5-F ureteroscopes, one 6.3- vs 8.5-F ureteroscopes, one 6- vs 7.5-F ureteroscopes, while three compared 7.5- vs >7.5-F ureteroscopes. Within the meta-analysis comparing 6.3- vs 7.5-F ureteroscopes, the small-calibre ureteroscopes were associated with a risk ratio [RR] for SFR of 0.99 (95% confidence interval [CI] 0.92-1.06), of 1.08 (95% CI 0.77-1.51) for overall complications, and a standardised mean difference in operative time of -14.5 min (95% CI -33.4 to 3.3 min). These results were virtually confirmed by all sensitivity analyses. No differences in the above outcomes were recorded for the comparison between 7.5- vs >7.5-F ureteroscopes. CONCLUSIONS:Within the present meta-analysis, the small-calibre ureteroscopes achieved comparable outcomes to large-calibre ureteroscopes. To overcome the substantial heterogeneity and residual confounding across studies, well-designed and adequately powered RCTs are required.

Informed consent is a cornerstone of ethically acceptable surgical interventions. Traditional methods primarily rely on verbal explanations by clinicians and, at times, the use of supplementary resources such as information leaflets. In the modern era, novel tools have emerged to facilitate and enhance the consent process. Examples include multimedia, 3D models, virtual and augmented reality, quick response codes, and artificial intelligence technologies such as large language models. This narrative review provides an overview of these aids, discussing their potential advantages and limitations. In addition, the influence of social media on the consent process is explored.

INTRODUCTION:BPH/male LUTS is a prevalent condition in the aging male population with multifactorial pathophysiology. Pharmacotherapy remains the cornerstone of treatment in patients who fail conservative treatment. 5-α-Reductase inhibitors (5-ARIs) are the only class of medication shown to reduce the risk of acute retention and BPH-related surgery and, thus, are commonly used along with other "short acting" medications in combination treatments. AREAS COVERED:Combination treatments with α-blockers and 5-ARIs have been investigated extensively in high quality trials that prove the long-term efficacy of such treatments with acceptable rates of side effects. Combination treatments involving 5-ARIs and other classes of medications (anticholinergics, b3 agonists, PDEI) have been shown to be beneficial in the short term and but studies with longer follow-up periods are required to fully establish their role. EXPERT OPINION:A-blocker/5-ARI combination treatment is a reasonable approach for patients with male LUTS/BPH who are at increased risk of disease progression or have incomplete response to monotherapies. Other combination treatments with 5-ARIs and PDEI or anticholinergics/β-3 agonists can be tried based on predominant symptoms or side effect profile, but patients should be informed about the lack of long-term data.

Kidney stone formers are at risk of loss of kidney function over time and have substantial morbidity as well as reduced quality of life (QoL) [1,2]. There is a need for earlier diagnosis, alongside metabolic investigation, to determine suspicion of secondary stone disease to enable earlier intervention and prevent progressive kidney damage [2]. Currently, there is a lack of best practice recommendations for forming a multidisciplinary team (MDT) to aid patient management of high-risk adult recurrent kidney stone formers. We propose a ‘SMART’ Stone MDT that aims to provide guidance on the role of an MDT, including Nephrologists, in the early identification, referral and assessment of adult high-risk kidney stone formers to advance patient care. Recommendations were developed by the expert Steering Committee (SC, 1 Nephrologist, 3 Urologists and 2 Biochemists/Geneticists) from the UK, Spain, Germany and Italy. These recommendations were voted on by invited specialists to determine their level of agreement, from ‘strongly agree’ to ‘strongly disagree’, via an online survey. With an agreement threshold set at 70%, the SC reviewed the survey results, additional comments and any areas of disagreement, before finalising the recommendations. A total of 44 recommendations were developed by the SC, designed to support the structure of an ideal MDT including team composition, patient identification and referral, planning and coordination, patient assessment, decision-making, communication, onward referral and care integration. Thirteen core recommendations were chosen as being the highest priority for the activities of an MDT. Of the 48 additional invited specialists, 29 voted on the core recommendations (5 Nephrologists, 22 Urologists and 2 Biochemists/Geneticists) from 19 countries across Europe, Canada, East Asia, South/Southeast Asia, and the Middle East. All 13 core recommendations reached the 70% agreement threshold.The remaining 31 recommendations were voted on by those specialists who opted-in to partake in an extended questionnaire (n = 15/21; 3 Nephrologists, 10 Urologists and 2 Biochemists/Geneticists). All 31 extended recommendations reached the 70% agreement threshold. 93% (n = 27/29) of responders agreed or strongly agreed that an MDT is required to improve the patient journey and provide the best outcomes for patients with complex stones. 100% (n = 29/29) of responders agreed or strongly agreed that the Nephrologist should be included in the MDT as a core team member. The main recommended roles and responsibilities of the Nephrologist from the perspective of an ideal MDT reached an agreement level of 80% (n = 12/15, extended questionnaire). Roles and responsibilities include but are not limited to, leading cases relating to patients on a medical pathway, metabolic assessment and interpretation of laboratory tests to establish a diagnosis and/or suspicion of secondary stone disease, medical management and follow-up and kidney function monitoring, and management of reduced kidney function. While the recommendations focus on the ideal situation, location-specific nuances, including healthcare setting, infrastructure and resource availability, should be taken into consideration. An ideal MDT process can achieve comprehensive, high-quality, and coordinated patient care, which is especially useful for patients with complex stone diseases. The role of the Nephrologist is important in the formation of an ideal MDT, to establish a correct diagnosis and/or suspicion of secondary stone disease, as well as medical management and follow-up to name a few. A high level of agreement was reached on core and extended recommendations relating to the implementation of an ideal MDT in identifying and managing high-risk stone formers.

Introduction and Objective: We aimed to look at the evidence for laser lithotripsy for bladder stones (BSs) to provide results from two centers on bladder calculi treatment. In addition, the outcomes of prostatic and other surgical interventions performed in nearly half of all patients.Methods: A retrospective analysis of two large European endourology tertiary centers for patients who underwent laser lithotripsy for BS between 2016 and 2024 (7 years). All patients provided consent and were counseled for the study accordingly, and the studies were registered as an audit in the individual centers.Results: A total of 122 patients were analyzed (mean age of 68.17 +/- 16.38 years; male:female ratio of 97:25). Thirteen (10.7%) patients had a preoperative long-term catheter. Overall, 42 (34.43%) patients had multiple stones (n = 2.19, +/- 2.08), with a median stone burden of 32.36 +/- 24.13 mm. The mean operative time was 61.6 +/- 37.25 minutes, with an overall stone-free rate (SFR) of 95.1% (n = 116). Postoperative complications were noted in nine (7.38%) patients, which included urinary tract infection or sepsis (n = 4, 3%), pain (n = 2, 1.6%), and bleeding/acute urinary retention/urethral stone (n = 1 each, 0.82%). All the complications were Clavien-Dindo I/II and treated conservatively. Six patients (4.9%) with planned concomitant surgical intervention needed a completion (second) intervention at a later date. Sixty patients (49.2%) had concomitant procedure along with their BS treatment. Twenty-two patients (18%) with a mean prostate size of 60.71 cc (+/- 30.50 cc) underwent a transurethral resection of prostate (n = 16, 13.1%) or bladder neck incision (n = 6, 4.9%). Others underwent ureteroscopy (n = 13, 10.7%), transurethral resection of bladder tumor (n = 5, 4.1%), suprapubic catheter repositioning (n = 10, 8.2%), or urethral dilation (n = 10, 8.2%). The mean hospital stay was 1.4 +/- 1.33 days.Conclusion: Laser fragmentation of BSs stands out as a safe and efficient choice with a good SFR and low risk of major complications, and perhaps should be considered the new gold standard for BS management. It also allows for concomitant treatment of enlarged prostate and other endourologic procedures with good outcomes.

Frailty refers to a state of increased vulnerability and is recognised to be multifactorial. It is associated with a higher likelihood for functional dependency and a reduced life expectancy. In the surgical setting, frailty has attracted increased attention in regard to how it can impact post-operative outcomes. Many research groups have explored ways to translate frailty into a clinical marker and represent it as a quantifiable measurement. To this end, there now exist a plethora of tools (over 50 tools) available that have been applied in a clinical and/or research setting across nearly all medical and surgical specialities. However, the large number of tools can make it challenging for clinicians to know which one to adopt. This article provides an overview of the commonly used tools in urological surgery. Most tools have been studied in the context of urological cancer surgery and consistently show that frailty is associated with poorer outcomes. Of note, none of the systems described were developed exclusively for purely urological studies. Many of the abovementioned systems require a face-to-face assessment and therefore preclude retrospective data collection. Frail patients may not therefore be eligible on account of either one of these and it may account for why research in this field is lacking. Important outcomes such as the discharge location and how ADLs have changed are also challenging to collect retrospectively. Further research should focus on developing a frailty scoring system that is customised for urological surgeries.

Background and objective: Elevated intrarenal pressure (IRP) may increase the risk of complications in patients undergoing ureteroscopy. As there is limited clarity on a threshold value for high IRP, how to manage high IRP, or which patients are at greater risk of complications due to high IRP, we used the Delphi methodology to understand expert opinion in this area. Methods: The Delphi process comprised two online surveys and an in-person meeting. During the in-person meeting, areas of disagreement and consensus were explored. Consensus statements were developed and voted on to determine the level of consensus. The study was granted a waiver by HML IRB Research and Ethics (reference number 2193). Key findings and limitations: The pan-European panel started with 12 and ended with 11 experienced endourologists. Eleven consensus statements were developed. The statements cover topics such as the definition of high IRP, complications linked to high IRP, and patient risk factors for these complications. After anonymous voting, consensus was achieved for all the statements. Two had a strong level and nine had a moderate level of agreement. There was no consensus on an IRP threshold, although the majority would be concerned for patient safety at a pressure above 61-80 cm H2O. Conclusions and clinical implications: Any IRP above normal physiological levels should be considered high. High IRP during ureteroscopy is a concern for patient safety. It is important to understand links between high IRP, patient characteristics, and complications. We call for additional research to better understand these risks and to inform refinements to clinical practice. Patient summary: A group of experts were asked their opinion on pressure within the kidney (intrarenal pressure, IRP) during a procedure called ureteroscopy (URS), when a narrow telescope is passed through the bladder and into the tube connected to the kidney. Statements that the panel agreed on were developed. These statements show that there is a concern about high IRP during URS as it may be linked to a higher risk of complications for the patient. More research is needed to better understand high IRP and its link to patient outcomes. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

The objective of this study was to perform a multi-centre and global study evaluating the clinical outcomes and complications associated with of URS for stone disease in patients aged 80 years and above. Retrospective analysis was conducted on patients aged ≥ 80 years who underwent URS for stone disease between January 2014 and December 2024, across 20 centres in 14 countries. A total of 679 patients aged ≥ 80 years underwent ureteroscopy (URS), with a median age of 83 years (IQR 81–86) and a male-to-female ratio of 1.2:1. Most patients were ASA grade 2 (52

A novel larger 5.1Fr working channel flexible ureteroscope for Direct-In-Scope Suction (DISS) has recently been introduced. However, the optimal stone dust size for successful evacuation without working channel blockage is currently unknown. In vitro assessment of the PU400A 9.2Fr ureteroscope (Zhuhai Pusen Medical Technology Co., Ltd, China) was performed with BegoStone particle sizes ≤ 2000 μm (size range 1000–2000 μm), ≤ 1000 μm (500–1000 μm), ≤ 500 μm (250–500 μm), ≤ 250 μm (125–250 μm) and ≤ 125 μm (63–125 μm), in a kidney calyx model. This was conducted with an empty working channel, and with occupancy by 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fibers. Primary outcome was complete suction-evacuation without working channel blockage. Secondary outcome was evacuation speed for particle sizes that did not have blockage. A stone particle size upper limit of 250 μm was found to achieve complete suction-evacuation without blockage, across all working channel occupancy situations. For stone particle size of range 125-250 μm, evacuation speeds were 35, 26, 13, 11 mm3/s across empty, 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fiber occupancy, respectively (ANOVA = p < 0.001). For stone particle size range 63-125 μm, evacuation speeds were 19, 14, 9, 8 mm3/s respectively (ANOVA = p < 0.001). The 5.1Fr working channel DISS ureteroscope allows a stone particle size limit of 250 μm to be suction-evacuated without blockage, even with laser fiber occupancy. With a laser fiber, a smaller 150 μm fiber size allows better particle evacuation speeds. Urologists should therefore aim for a dust particle size of ≤ 250 μm in routine DISS with the 5.1Fr working channel ureteroscope, for effective intraoperative stone evacuation.

Our aim was to compare hand radiation exposure using leaded vs. regular latex surgical gloves in endourological procedures. We conducted a single-center prospective comparative study between January 2017 and December 2020. Surgeon 1 wore leaded surgical gloves, while Surgeon 2 voluntarily wore regular latex surgical gloves. A ring badge and chest dosimeters were used to estimate hand and whole-body scattered radiation dose in all endourological stone procedures (ureteroscopy (URS), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL)). We found that Surgeon 1 and 2 performed a mean of 158 (SD 15.2) and 158 (SD 15.1) procedures/year, respectively, for a total of 1,092 between 2017 and 2020 between the two surgeons (696 URS/RIRS and 396 PCNL). The overall mean hand annual radiation exposure dose for Surgeon 1 and 2 was 2.87 mSv (SD 1.3) and 14.89 mSv (SD 7.87), respectively (p = 0.027), which corresponds to a mean of 0.02 (SD 0.02) and 0.1 mSv (SD 0.1) per procedure (p < 0.001). The estimated annual scattered radiation was 0.0012 and 0.0016, respectively (p = 0.63). We concluded that the use of leaded gloves in endourological stone procedures showed a significant reduction of radiation dose per year and per procedure compared to regular latex gloves; no increase in whole-body scattered radiation was detected with their use. We believe that the use of leaded gloves may be recommended, especially in urologists who dedicate most of their practice to endoscopic stone surgery. Further studies are needed to define whether these gloves could increase patient radiation exposure.

The SMART Stone Multidisciplinary Team (MDT) recommendations aim to provide guidance on the role of the MDT in the early identification, referral and assessment of adult high-risk recurrent kidney stone formers to advance patient care. Recommendations were developed by the expert Steering Committee (SC) comprising of three Urologists, one Nephrologist, and two Biochemists/Geneticists from the UK, Spain, Germany, and Italy. These recommendations were voted on by invited specialists via an online survey to determine their level of agreement, from ‘strongly agree’ to ‘strongly disagree’. With an agreement threshold set at ≥ 70

Objective: To evaluate outcomes of same sitting bilateral retrograde intrarenal surgery for kidney stone in patients aged > 70 years. Methods: We retrospectively reviewed patients with bilateral kidney stones who underwent same sitting bilateral retrograde intrarenal surgery in 21 centers (January 2015-June 2022). Inclusion criteria: patients aged > 70 years, bilateral kidney stones diagnosed due to either unilateral or bilateral symptomatic presentation. Patients were divided into 2 groups: group 1, patients aged 70-74 years, group 2, patients aged > 75 years. Results: There were 86 patients in group 1 and 60 patients in group 2. There was no difference between the groups for gender, ASA score, BMI, comorbidities, presenting symptoms, and positive preoperative urine culture. Group 2 had a significantly higher proportion of recurrent stone formers (54.7 vs. 35.0%, p = 0.03), and a higher proportion of bilaterally pre-stented patients were present in group 2 (37.9 vs. 18.6%). There was no difference in total operation time and rate of post-operative uni-and bilateral stent positioning. Surgery was discontinued in 15.1% and 18.3% of cases in groups 1 and 2, respectively (p = 0.773). Median length of postoperative stay was 2 days in both groups. The most frequent complication was fever requiring antibiotics and prolonged admission (10.5% in group 1 and 11.7% in group 2, p > 0.99). Sepsis rate was 2.3% patients in group 1 and none in group 2. In group 1, 1.2% required a blood transfusion due to hematuria. Bilateral stone-free rate was similar (60.0 vs. 47.7%, p = 0.194) in both groups. Conclusions: Same sitting bilateral retrograde intrarenal surgery in elderly patients demonstrated an acceptable safety profile with good bilateral stone-free rate. (c) 2025 AEU. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.