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Introduction: There is a gap in the available literature and guidelines concerning the optimal approach for treating allograft stones, which currently include external shockwave lithotripsy, ureteroscopy and laser lithotripsy, or percutaneous nephrolithotomy. The objective of this systematic review was to evaluate the safety and effectiveness of URS as a treatment option for patients in this scenario., Evidence Acquisition: A comprehensive search of the literature was conducted until August 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023451154)., Evidence Synthesis: Eleven articles were included (122 patients). The mean age was 46.9±9.5 years, with a male-to-female ratio of 62:49. The preferred ureteral reimplantation technique was the Lich-Gregoire. The mean onset time was 48.24 months. Acute kidney injury, urinary tract infections and fever were the most frequent clinical presentations (18.3% each), followed by hematuria (10%). The mean stone size measured 9.84 mm (±2.42 mm). Flexible URS was preferred over semirigid URS. The stone-free rate stood at 83.35%, while the overall complication rate was 13.93%, with six (4.9%) major complications reported. Stones were mainly composed of calcium oxalate (42.6%) or uric acid (14.8%). Over an average follow-up period of 30.2 months, the recurrence rate was 2.46%. No significant changes in renal function or allograft loss were reported., Conclusions: URS remains an efficient choice for addressing de-novo allograft urolithiasis, offering the advantage of treating urinary stones with a good SFR and a low incidence of complications. Procedures should be performed in an Endourology referral center.

Background: Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones., Methods: A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL., Results: Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center., Conclusions: Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.

The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.

Background: The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs., Methods: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement., Results: Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%)., Conclusions: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.

Introduction: Ureteral stent insertion is frequently chosen after upper tract endourological procedures. The use of stents carrying a suture string is sometimes used to facilitate the extraction of the stent. In this systematic review and meta-analysis, we aimed to provide stronger evidence for the efficacy of string stents, by comparing them to non-string stents, in matters of patients' quality of life (QoL), stent-related symptoms (SRS) and complications., Evidence Acquisition: A systematic review was conducted on PubMed, SCOPUS, Cochrane, EMBASE and Web of Science. The studies included were only comparative randomized controlled trials which included at least one group with tethered ureteral stent and one group with standard stent after the performance of endoscopic surgery for lithiasis of upper urinary tract. Primary endpoints were QoL expressed as general health, urinary symptoms as well as impact on work performance and SRS, expressed by VAS score. Secondary endpoints included complications such as stent migration, stent dislodgement, urinary tract infections (UTIs), emergency room visits and retained stent., Evidence Synthesis: We identified nine studies to be included in the qualitative synthesis and 3 randomized controlled trials to be included in the quantitative synthesis and the meta-analysis. The statistical difference in the stent related QoL was insignificant. General health was less affected in the non-string group. The urinary symptoms and the impact on work performance were similar between the groups. VAS pain score during the time that the patients were stented was insignificantly less in the non-string group, while VAS pain score was higher in the non-string group at extraction. Stent dislodgement was more frequent in the string group. There was no difference between the groups concerning the rate of UTIs., Conclusions: Non-string stents affected less the patients' QoL, in terms of general health and urinary symptoms, caused less stent related pain in cases of stent in situ and caused stent dislodgment in fewer patients. On the contrary, string stents caused less pain at extraction. All the aforementioned differences did not reach statistical difference.

The incidence of stone disease continues to rise. Surgical management options including shockwave laser lithotripsy, percutaneous nephrolithotomy, and ureteroscopy with stone extraction and/or lithotripsy. The technology associated with the ureteroscopic treatment of stones has advanced significantly over the past decade and this review focuses on many of the accessory devices that can be employed to aid in the procedure.

The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

Over the past 2 decades, ureteroscopy has changed from a procedure considered second-line to shockwave lithotripsy to a commonly performed procedure for renal and ureteral stones. The increase in the use of ureteroscopy is due largely to improvements in technique and technology during this time period. Herein we review outcomes of ureteroscopy in terms of success rates, complications, and unique patient populations. This work will synthesize the data as it pertains to the practice of ureteroscopy for all endourological indications, including stone disease and management of upper tract urothelial carcinoma, as well as review state-of-the-art techniques.

Open ureterolithotomy and pyelolithotomy used to be first line therapy for treating kidney and ureteral stones. With the advent of shockwave lithotripsy, open stone surgery became less prevalent, but once ureteroscopy became more prevalent, open stone surgery became all but extinct. Advances in smaller, more flexible endoscopes and improvements in intracorporeal lithotripters, ureteroscopy has become a mainstay of therapy for kidney stones. The holmium:yttrium-aluminium-garnet laser can be utilized through flexible instruments and fragments any stone no matter what it is composed of. Digital image ureteroscopes with chip-on-the-tip technology has improved our visualization during ureteroscopy. What is next? We examine potential directions from current research. Pharmacologic manipulation for ureteral dilation may obviate the need for pre-stenting or balloon dilation. Advances in ureteroscope technology will likely see the biggest advances. Different ureteroscopic platforms and the user interface with the surgeon will progress. Robotic manipulation of the endoscope is an eventual reality with improved ergonomics and improved performance to reach all areas of the kidney. Single-use ureteroscopes are already a reality and offer a digital image with full deflection with every use and without having to worry about sterilization and costly repairs. Lastly, advancements in nanotechnology and robotics will see the potential for miniaturized robots that could be administered intravesically to identify the stone and to disintegrate it. The only prediction that can be made about the future of ureteroscopy is that we do not know how it will look. The future of ureteroscopy is exciting and most definitely will be unrecognizable to the surgeons of today.

Ureteroscopy is one of the most commonly performed surgeries for kidney stones and one of the most commonly performed surgeries by urologists overall. Although generally safe, recognizing and understanding the potential complications of ureteroscopy is paramount. Intraoperative complications discussed in this review include difficult access, bleeding, ureteral false passage, perforation, and avulsion. Postoperative considerations discussed include extravasation, infection, postoperative imaging for silent obstruction, and ureteral stricture. We place special emphasis on the management of ureteral stricture, which can be associated with significant morbidity.

Renal stones in the modern era are most commonly treated with minimally invasive techniques and using endourological procedures. However, for more complex cases, there is renewed interest in exploring laparoscopic or robotic techniques that can offer patients significant benefits over otherwise multiple endourologic or open surgical intervention. In clinical circumstances with anomalous anatomy, indication for concomitant reconstruction, or previously failed endourological intervention, robotic and laparoscopic approaches may offer suitable, if not more effective, treatment options.