Ureteral stents are widely used following ureteroscopy (URS), yet several aspects of their management remain non-standardized despite contemporary EAU and AUA guideline recommendations. This study evaluated contemporary international practices and identified gaps in ureteral stent use among endourologists. A cross-sectional international survey consisting of 58 items across nine domains was distributed via social media, major urological meetings, and the EAU Endourology Section. Only fully completed responses were analyzed. Descriptive statistics were used, with continuous variables reported as medians and categorical variables as frequencies and percentages. A total of 121 respondents from 48 countries were included. Stent placement remained common after uncomplicated ureteroscopy and was nearly universal in complicated cases. Pre-stenting was applied selectively, most commonly after failed ureteroscopy and for ureteral dilatation. A 6 Fr stent and polyurethane material were the preferred choices. Stent-related symptoms were frequent, with urgency and frequency predominating, followed by hematuria. Pharmacologic management varied, and conservative treatment was commonly used for post-stenting infections. Notably, 45

To evaluate the reliability of the intrarenal fluid temperature (IFT) and intrarenal pressure (IRP) fluctuations using a 7.5 Fr single-use ureteroscope with temperature and pressure sensors and ureteral access sheath (UAS) in an in vivo porcine model. Two female pigs underwent flexible ureteroscopy using a 150 W Ho: YAG laser with a 200 μm fiber. The energy settings varied from 10 W to 60 W. A thermocouple was used for the documentation of IFT and a pressure sensor was used for the documentation of IRP, while the laser was activated for 30 s, without interruption, per trial. Twenty trials were performed per kidney unit. The recordings conducted by the scope’s sensors were evaluated in comparison to the external recordings. The value of 43 °C was considered to be the temperature upper limit threshold, and the value of 30 mmHg was set as the pressure safety limit. The correlation of the recorded data was the primary endpoint of the study. The IRP and IFT elevations were considered the secondary endpoint. Overall, 40 measurements were conducted. The correlation between the conventional and scope’s measurements was statistically significant in both IRP and IFT settings. Pearson’s scores varied from 0.967 to 0.993 with p < 0.001. Despite the fact that IFT elevation was directly associated with laser activation, the tissue damage threshold was not reached across all experimental trials. The same observation was performed regarding the pressure control. This in vivo experimental study demonstrated that high-power Ho: YAG lithotripsy with the novel 7.5 Fr single-use ureteroscope with sensors is safe and feasible, while allowing a reliable and close monitoring of the major safety factors.

To evaluate the impact of position of the external end of the ureteral access sheath (UAS) on the regulation and management of intrarenal pressure (IRP) using 4 different scopes with varying working channel diameters. An ex-vivo study evaluating four single-use flexible ureteroscopes was performed. The IRP measurements were performed with the flexible ureteroscopes only and with 10/12Fr and 12/14Fr UASs together with flexible ureteroscopes. The main variable of interest was the position of the external end of the UAS termed as high (30 cm above), middle (15 cm above) and low (at the kidney level). The highest maximal IRPs were recorded with the 9.2Fr PU400A Pusen scope in all settings. Minor differences were noted between the measurements with no UAS and with UAS in high position. Decreasing the end position of the UAS from high to middle and low resulted in significant decline of IRPs, 33.3

Background/Objectives: In an attempt to combine the benefits of the Holmium:YAG (Ho:YAG) laser and Thulium Fiber Laser (TFL), the "Magneto" mode lowers the peak power of the Ho:YAG laser, generating longer duration pulses. The purpose of this study is to compare the effect of the standard virtual basket (VB) Ho:YAG laser, Magneto Ho:YAG laser and TFL on soft tissue in an ex vivo model. Methods: Two renal units from a female pig were used for the current experiment. Sixteen distinct areas were defined. Each area included three parallel lines, which were made with the three different laser technologies. The VB Ho:YAG laser was used for the first line and the Ho:YAG laser in the "Magneto mode" was used to generate the second line, while the third line was performed with a TFL in short pulse mode. The same laser settings (1 J/10 Hz/10 W) and the same fiber diameter (200 μm) were used for all three laser incisions. The same surgeon performed all incisions with a standardized and repeatable technique, controlling hand speed and distance of laser fiber from kidney surface using the stabilization setup. Sections of the selected areas produced distinct paraffin blocks, each one containing three parallel laser lines. Two independent pathologists evaluated the incision depth, incision width, coagulation depth and carbonization effect of the three different lasers. Results: Although the incision depth and the carbonization effect were comparable between the three lasers, incision width and coagulation depth showed a statistically significant difference. Median incision width was 1.17 (1.04, 1.99) mm for the VB Ho:YAG laser, 1.05 (0.89, 1.50) mm for the Magneto Ho:YAG laser and 0.82 (0.65, 0.88) mm for the TFL (p = 0.001). The coagulation depth was 0.49 (0.41, 0.56) mm for the VB Ho:YAG laser, 0.51 (0.39, 0.59) mm for the Magneto Ho:YAG laser and 0.18 (0.17, 0.23) mm for the TFL (p < 0.001). During post hoc analysis for the three comparisons, the differences between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL were statistically significant for both parameters. Conclusions: Both the VB and Magneto Ho:YAG lasers produced laser incisions with statistically significant greater incision width and coagulation depth than the TFL on the ex vivo model. Overall, the Magneto Ho:YAG laser was associated with the greatest median coagulation depth. Post Hoc Man-Whitney tests for the three comparisons revealed statistically significant differences only between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL. This finding could potentially be translated into better haemostasis during endourological soft tissue surgery. The implementation of additional studies, both experimental and clinical ones, is of outmost importance to draw safer conclusions.

To critically analyze the methodology of imaging data reporting, including timing, modality and stone burden measurement perioperatively, from recently published literature on surgical interventions for stones, and to develop a scoring system to evaluate its quality. Articles reporting treatment outcomes in adult patients, published in 2020–2021 by preselected journals, were searched on PubMed and Embase. Recorded data for statistical analysis included type of study and intervention, pre- and postoperative imaging modality and timing, stone burden assessment method and measurement, stone free and treatment success definition or their differentiation. A new 7-point checklist (iSTAR—Imaging for Stone Treatment Assessment Reporting) was developed. A total of 122 studies were included. Several papers did not report on pre- or postoperative imaging modality (13.9

To evaluate the real-time safety profile and intrarenal pressure (IRP) dynamics of two suction-assisted ureteroscopic systems, the Direct In-Scope Suction (DISS) and Flexible and Navigable Suction (FANS) ureteral access sheath, in an ex-vivo model. Four porcine kidney-ureter units were used, harvested from two female pigs (32–34 kg). A 20G intravenous catheter was inserted into the middle calyx for continuous IRP monitoring via a pressure transducer and monitor. Each kidney underwent four experimental configurations combining 7.5 Fr PU3033AH or 9.2 Fr PU400A DISS scopes with 9.5/11.5 Fr or 12/14 Fr FANS sheaths. Irrigation was performed using a manual hand pump, and suction was applied at 100 mmHg either through the ureteroscope or sheath. Measurements included baseline and maximal IRPs, suction-induced changes, mucosal injury, and time to endoscopic stone-free status (ESFS). Sixteen experiments were completed. Activation of suction consistently reduced IRP across all settings. The The 7.5 Fr DISS + 9.5/11.5 Fr FANS configuration achieved the lowest pressures (4–12 mmHg) but caused pelvicalyceal collapse and six mucosal injuries. In contrast, the 9.2 Fr DISS + 12/14 Fr FANS combination-maintained IRP between 12 and 28 mmHg with efficient fragment evacuation and minimal collapse. Both DISS and FANS effectively maintained IRP within a safe range. Controlled, balanced suction was crucial for safety, while excessive negative pressure or prolonged manual irrigation risked collapse and mucosal injury. The 9.2 Fr DISS + 12/14 Fr FANS configuration demonstrated stable pressure control and efficient performance in this experimental model.

To evaluate the effectiveness of MediNik hydrogel for retrieval of stone fragments of varying sizes and to assess how application technique influences its performance. An in vitro experimental study was conducted using blood sample containers, natural stone fragments ranging from 0.2 to 2 mm, a 7.5 Fr single-use flexible ureteroscope, and a 2.2 Fr endoscopic basket. The MediNik system consists of a blue alginate component (K1) and a yellow calcium-based activator (K2) that interact to form a hydrogel. The evaluated parameters included K1:K2 ratios (2:1, 1:1, 1:2, and 1:3), stone fragment size (0.2–0.45 mm, 0.45–0.6 mm, 0.6–1.0 mm, 1–2 mm, and mixed fragments), application method (surface application versus delivery of K1 into the fragment mixture), and waiting time (3, 5, and 10 s). Hydrogel performance was strongly influenced by the application technique. Effective integration of the two components occurred when K1 was delivered directly into the stone fragments and K2 was subsequently applied, particularly at K1:K2 ratios of 1:1, 1:2, and 1:3. Successful retrieval was achieved across all fragment sizes, including mixed fragments. Surface application of the components alone did not consistently produce a stable hydrogel clot. Stable MediNik hydrogel clot formation was achieved at K1:K2 ratios of 1:1, 1:2, and 1:3 when K1 was applied first and followed by K2, with effective clot formation observed at waiting times of 3, 5, and 10 s. Stone fragment size did not affect clot formation. The most reliable clot suitable for basket extraction was obtained using intrafragment application of the alginate component followed by calcium binder delivery.

Background/Objectives: Recently, a 6.3 Fr single-use flexible ureteroscope (f-URS) was introduced to the market. The purpose of this pilot study is to present our experience with it during Endoscopic Combined Intrarenal Surgery (ECIRS) and to compare its performance with the conventional 7.5 Fr scope. Methods: For percutaneous access, renal puncture was performed in a nonpapillary approach. Regarding retrograde access, for the first group, a 7.5 Fr single-use f-URS was used, while for the second group, a 6.3 Fr single-use f-URS was utilized. Lithotripsy was primarily performed in an antegrade manner, using the Lithoclast Trilogy®. In cases where stones could not be reached with a nephroscope, retrograde lithotripsy was performed with either a Holmium:YAG laser or a Thulium Fiber Laser. Results: In total, 45 patients were included. Of these, 23 patients underwent ECIRS with the 6.3 Fr f-URS and 22 with the 7.5 Fr f-URS. The mean operative time, fluoroscopy time and lasing time were 59.5 ± 5.6 min, 139.7 ± 14.2 s and 18.4 ± 2.7 min in the 6.3 Fr group and 57.1 ± 3.9 min, 133.8 ± 29.7 s and 18.6 ± 1.9 min in the 7.5 Fr group, respectively. Two patients in the 6.3 Fr group and three patients in the 7.5 Fr group experienced Grade II complications. Stone-free rates were 91.3% in the 6.3 Fr group versus 86.4% in the 7.5 Fr group. Conclusions: The use of a 6.3 Fr f-URS during ECIRS is potentially a feasible, safe and efficient approach. Both the 6.3 Fr and 7.5 Fr scopes were associated with comparable outcomes during ECIRS. Additional studies are needed so as to draw safer conclusions.

BackgroundRadical prostatectomy remains a key curative treatment for localized prostate cancer which has undergone continuous transformation. Recent developments in robot-assisted and single-port surgery have followed the concept of minimizing morbidity while maintaining oncologic safety. Furthermore, the integration of artificial intelligence and novel diagnostic tools have transformed the modern surgical workflow. Therefore, the aim of this study is to give an overview of the evolution of surgical techniques, functional and oncological outcomes, and available surgeon-assisting concepts.MethodsWe conducted a non-structured review to summarize the evolution of radical prostatectomy techniques and recent developments in surgeon-assisting tools. Relevant English-language publications were identified through a targeted PubMed search using predefined keywords related to, laparoscopic, robot-assisted, Retzius-sparing, and single-port approaches. Key studies, systematic reviews, and meta-analyses were used and synthesized to provide a comparative overview. Furthermore, studies focusing on integration of artificial intelligence, novel diagnostic tools and targeted surgery are discussed.ResultsLaparoscopic surgery aims to reduce morbidity yet is technically demanding. Robotic-assisted approaches improve visualization and precision, leading to faster recovery and earlier continence recovery. Newer Retzius-sparing and single-port techniques show promising functional results, though evidence is still limited. Novel diagnostic tools including image overlay, targeted surgery, and fast and accurate intraoperative pathological assessment of resection margins are increasingly shaping modern radical prostatectomy.ConclusionRadical prostatectomy has evolved into a minimally invasive, technology-driven procedure with improved recovery and functional outcomes. Advances in robotics, imaging, and artificial intelligence enhance surgical precision. Ongoing innovation and long-term data will define the future of prostate surgery.

Objective: Fluoroscopy is an important component of retrograde intrarenal surgery (RIRS), as it facilitates safe and accurate access, guidance, and intraoperative navigation. Fluoroscopy during surgery exposes patients and medical personnel to the harmful effects of ionizing radiation. To reduce radiation exposure, multiple strategies have been proposed. The objective of this review is to analyze strategies for minimizing radiation exposure during RIRS and to provide recommendations for their implementation. Methods: A comprehensive literature review was performed by searching the PubMed, Cochrane Library, EMBASE, and Web of Science databases, as well as the ClinicalTrials.gov registry, for publications on strategies for reducing fluoroscopy use during RIRS, using various combinations of the following Medical Subject Headings: “fluoroscopy”, “radiation safety”, “radiation exposure”, “urology”, “endourology”, “flexible ureterorenoscopy”, “FURS”, “retrograde intrarenal surgery”, “RIRS”. Results: A substantial corpus of evidence, encompassing original articles, clinical trials, and narrative and systematic reviews, was identified. Several preoperative measures, including thorough analysis of available imaging studies and the application of quality checklists to guarantee optimal patient positioning, C-arm settings, and the use of radiation protection equipment, have been associated with a significant reduction in radiation exposure. Intraoperatively, the use of fluoroless or fluoroscopy-free RIRS, along with equipment optimization techniques such as intermittent fluoroscopy, collimation, and last image hold, has been identified as a promising approach for radiation reduction. The implementation of radiation safety and simulation-based training can further decrease radiation exposure. Conclusion: Minimizing radiation exposure during RIRS necessitates a comprehensive strategy that integrates careful preoperative planning, fluoroless or fluoroscopy-free techniques, equipment optimization, and radiation safety training and education. Current evidence suggests that these approaches can be performed safely and effectively in appropriately selected patients. However, further high-quality randomized controlled trials are needed to confirm these findings and guide their broader adoption.

To evaluate the irrigation flow parameters of a 3.6Fr working channel in single-use flexible ureteroscopes with empty and without an instrument in the straight and flexed tip positions. An in-vitro experimental study including 8 single-use flexible ureteroscopes of varying size ranging from 6.3Fr to 9.0Fr in diameter and marketed as having a 3.6Fr working channel. The evaluation was performed under three different conditions: (1) With empty working channel, (2) With a 272 μm laser fiber (3) With a 2.2Fr nitinol basket. The trials were performed with the distal tip of the scope in a straight position and with right and left complete deflection. The maximal and minimal irrigation flow rates of 37.0 and 26.5 ml/min were observed with the 7.5Fr HU30S and with 6.3Fr HU30M HugeMed, respectively. The 6.3Fr HU30M scope was associated with statistically significant worse irrigation flow rates compared to 7.5Fr HU30S and 9.0HU30 scopes under all conditions. Deflection of the scopes affected the flow rates in up to 11

BACKGROUND:Pediatric urolithiasis guidelines recommend ESWL, RIRS, or PCNL for stones within the 10-20 mm range but this broad interval often complicates treatment selection. This systematic review aimed to define a clearer, evidence-based stone size cutoff to improve clinical decision-making. METHODS:A systematic review and meta-analysis were performed (PROSPERO CRD420251012163) according to PRISMA 2020 guidelines. Pediatric studies published from 2014 to 2025 were searched across major databases. Eligible studies reported stone size and at least one outcome, including stone-free rate, residual fragments, retreatment, or complications. Studies without quantitative data were excluded. Early and long-term complications as well as instrumentation were analyzed. Pooled estimates were calculated using random-effects models. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS:Seventy-six study arms (N.=5294) reported stone size data. The pooled mean was 16.03 mm (95% CI 14.60-17.47; I2=99.9%). Stones treated with ESWL averaged 12.29 mm, RIRS 12.49 mm And PCNL 20.16 mm, indicating PCNL was used for larger stones (P<0.001). In 113 studies reporting SFR, pooled rates were 0.801 for ESWL, 0.826 for RIRS And 0.893 for PCNL, with PCNL showing higher SFRs. Considerable heterogeneity was observed And differences in complication profiles and instrumentation were identified as important factors influencing treatment outcomes beyond stone-free rates alone. CONCLUSIONS:A 15-mm stone size threshold appears clinically meaningful and provides clearer guidance than the traditional 10-20 mm range in children. ESWL and RIRS are appropriate options for stones <15 mm, whereas PCNL is more suitable for larger stones. Beyond stone-free rates, complication profiles and instrumentation should be considered when selecting treatment. Study heterogeneity and potential publication bias remain important limitations.

Background and Clinical Significance: Metallic stents represent a breakthrough in the treatment of ureteric obstruction, improving patient quality of life. Despite their advantages, management of encrustation remains a difficult complication to address. This case series highlights the rare occurrence of permanent ureteral Wallstents remaining indwelling for over 20 years. It emphasizes that the function of these older devices can be successfully preserved using minimally invasive techniques. Case Presentation: This case series details three patients, two males, aged 75 and 69 years, diagnosed with colon cancer, and one female, aged 67 years, with cervical cancer, who presented with obstructive uropathy due to extrinsic malignant compression. As a therapeutic strategy, permanent ureteral Wallstents were placed in all three patients. Over time, the stents developed significant encrustation, leading to secondary obstruction. Clinical manifestations of this complication varied, ranging from asymptomatic hydronephrosis to acute symptomatic uropathy characterized by fever and localized pain. All cases were treated endoscopically with Ho:YAG laser lithotripsy, and urine flow was successfully restored. During the follow-up period, one patient experienced two recurrences that were managed with the same technique, another remained completely symptom-free, and the third was lost to long-term follow-up. Remarkably, the stents have remained functional for over 20 years post-implantation. Conclusions: This is a rare report documenting permanent ureteral Wallstents with such prolonged indwelling time. Furthermore, our findings suggest that through minimally invasive techniques, the function of these devices can be successfully preserved.

Thulium:YAG laser generators have recently been developed, enabling pulsed energy delivery, further expanding the armamentarium of available laser devices for endoscopic enucleation of the prostate (EEP). The current systematic review summarizes all applications of pulsed Thulium:YAG generators during EEP. In line with the PRISMA guidelines, the protocol of this systematic review was a priori registered to OSF database, while three different databases (PubMed, Scopus and the Cochrane Library) were carefully screened from database inception to 4 May 2026. A dedicated search string was applied for all three databases: (pulsed OR hybrid) AND (thulium:YAG OR tm:YAG). A manual search was also performed where appropriate. Both the search strategy and the inclusion criteria were guided by the PICO (Patients, Intervention, Comparison, Outcome) framework. Eight studies fulfilled the predefined criteria and were included in this systematic review. The purely pulsed Dornier Thulio generator was used in six studies, while the hybrid LISA RevoLix HTL generator was used in two studies. Three studies were non-comparative, while five studies were comparative. Four studies compared the pulsed Thulium:YAG and the Holmium:YAG laser technologies and one study compared the outcomes between miniaturized and standard pulsed Thulium:YAG EEP. Mean operative time across studies ranged from 40.8 ± 21.7 to 101.7 ± 18.5 minutes, while the enucleation and morcellation times ranged from 18.3 ± 8.9 to 83.7 ± 17.2 minutes and from 10.2 ± 10.1 to 18 ± 5.1 minutes, respectively. The Grade I–II and III–IV complications rates, according to Clavien-Dindo Classification ranged from 1

Purpose of review The purpose of this systematic review is to summarize all applications of simulation training in percutaneous nephrolithotomy (PCNL), including virtual reality (VR) simulators, 3D-printed and ex vivo models, and cadavers. Recent findings A systematic search of PubMed, Scopus, and Cochrane databases was performed. The simulation method varied between studies. 3D models were used in seven studies, cadavers were used in two studies and VR simulators were used in seven studies. The VR simulator was Marion K181 in two studies, the PERC Mentor in two studies, and the C-Arm Trainer simulator in two studies. One study used 3D ultrasound VR simulation derived from 2D CT scans. Ex vivo models were reported in four studies, while one study used a simple nonbiological model. The puncture method was ultrasound-guided in 9 studies, fluoroscopy-guided in 12 studies, and both methods in 2 studies. Both triangulation and bull's-eye techniques were reported during fluoroscopy-guided punctures, while one study also reported iPad assistance during puncture. Summary Simulation training in PCNL is both feasible and effective, with proven benefits for urologists of all levels of expertise and patients. Recently, innovative simulation-based teaching approaches have been described, using the already established simulators.

To evaluate the intrarenal temperature (IRT) variations using the 9.2Fr and 7.5Fr flexible ureteroscopes featuring direct-in-scope suction (DISS-FURS) in an in-vitro set up in different inflow and outflow irrigation conditions. The experimental setting consisted of two DISS-FURS: a 7.5Fr ureteroscope with a 3.6Fr working channel (WC), and a 9.2Fr scope with a 5.1Fr WC. An Aldaver upper urinary tract model was used, and IRT was continuously monitored using a calibrated digital thermometer. Temperature dynamics were assessed by measuring the time required for IRT to increase from physiological baseline (37 °C) to 43 °C, from 43 to 50 °C, and the time required for IRT to decrease from 50 °C to 43 °C and to 37 °C following laser deactivation. Measurements were performed using a 272-µm laser fiber. A Holmium: YAG laser was activated continuously at power settings of 10 and 20 W. Experiments were conducted under the following conditions: with/without ureteral access sheath (UAS), with gravity-driven irrigation alone, with manual pump-assisted irrigation, and with/without activation of the DISS system. Thermal dose was calculated using the cumulative equivalent minutes at 43 °C (CEM43). A total of 32 experimental cohorts (96 experiments) were analyzed. For the 7.5Fr DISS FURS, the safest combinations, defined by slower IRT rise and more controlled thermal profiles, were those with manual pump-assisted irrigation, use of UAS and no DISS activation. IRT increased more rapidly at 20 W in cohorts combining DISS activation without manual pump assistance and without UAS. In experiments performed with the 9.2Fr DISS FURS, manual pump-assisted irrigation and the use of UAS represented the safest maneuver for maintaining controlled IRT levels. The larger 5.1Fr WC allowed increased inflow, prolonging the time to critical temperature thresholds even when DISS was activated. The combination of manual pump-assisted irrigation, UAS use, and the 9.2 Fr DISS flexible ureteroscope with a 5.1 Fr working channel provided the most favorable intrarenal temperature profile. In contrast, simultaneous activation of suction and laser with the smaller 7.5Fr scope, particularly without adequate irrigation, may increase thermal risk and should be used with caution. These findings suggest that optimizing irrigation dynamics and coordinating suction use are key to minimizing thermal risks during DISS-assisted FURS. Further clinical studies are warranted.