Modernizing Kidney Stone Treatment: Devices, Data, and Clinical Impact

Kidney stones are an increasingly common public health problem, with notable increases observed in women¹ and children.² Myriad treatment options exist, ranging from extracorporeal shock wave lithotripsy to ureteroscopy to percutaneous nephrolithotomy. A challenge for clinicians is removing enough of a patient’s stone burden and residual fragments as possible to avoid repeat procedures.

In recent years, there has been an explosion of innovative technology to enhance the safety and efficiency of stone treatment. In this video series, which can be viewed in full on HCPLive sister brand Urology Times, urologists Karen L. Stern, MD, and Naeem Bhojani, MD, FRCSC, do a deep dive into these technologies, highlighting their pros and cons, learning curve, and future considerations.

The discussion, which is included in HCPLive’s This Year in Medicine series, begins with a reflection on how quickly technology in endourology has accelerated. Only a few years ago, suction-assisted ureteroscopy was considered an unrealized aspiration. More recently, however, the field has been inundated with novel devices and refinements, forcing clinicians to evaluate how best to incorporate them. According to Stern and Bhojani, this rapid influx of innovation has allowed surgeons to take on larger stones ureteroscopically and has created the perception—supported by clinical experience—that stone-free rates and procedural safety are improving. They acknowledge that formal classifications of stone-free outcomes do not always mirror these impressions, yet their day-to-day practice suggests meaningful gains.

They emphasize that suction technology is only one part of a broader wave of progress. Enhanced scopes and major advancements in laser platforms, such as thulium fiber systems and refined pulse modulation, have improved efficiency in dust production and visibility during surgery. Meanwhile, the trend toward smaller scopes aids maneuverability and access. Together, these tools have arrived at a moment when the field was grappling with the limitations of traditional ureteroscopy, especially the realization that many patients were not as stone-free as surgeons previously assumed. This discrepancy served as a major motivator to explore suction-based methods, which now consistently outperform conventional approaches.

The conversation also touches on intrarenal pressure, an aspect of ureteroscopy that has become easier to assess thanks to new scopes capable of real-time monitoring. The introduction of suction has shown a favorable impact on these measurements by facilitating continuous fluid removal, helping maintain lower pressures even during high-flow irrigation. Although the full clinical implications are still being understood, parallels from percutaneous surgery—where suction reduces infections and postoperative complications—suggest similar benefits may emerge for ureteroscopy. The speakers highlight early data from their own work showing that, despite high irrigation rates, suction systems effectively keep pressures down through both passive and active fluid evacuation.

References:

1. Chen KW, Meskawi M, Miller LE, et al. Trends in kidney stone prevalence among U.S. adults: a concerning contemporary gender analysis from the NHANES database. Can Urol Assoc J. 2025;19(2):58-60. doi:10.5489/cuaj.8935

2. Tasian GE, Ross ME, Song L, et al. Annual incidence of nephrolithiasis among children and adults in South Carolina from 1997 to 2012. Clin J Am Soc Nephrol. 2016;11(3):488-96. doi:10.2215/CJN.07610715