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To evaluate factors affecting the outcomes of short-term Mono-J insertion for 6 h following ureteroscopic stone removal. Patients treated with a Mono-J for 6 h after ureterorenoscopy and stone removal were analysed. FaST 1 and 2 (Fast Track Stent Studies), two consecutive single academic centre studies, were conducted between August 2014 and April 2018. In each study, we randomized patients with renal or ureteral calculi to two groups before ureterorenoscopy. FaST 1 compared a Mono-J insertion for 6 h versus Double-J insertion for 3–5 days after ureterorenoscopy. FaST 2 compared a Mono-J insertion to a tubeless procedure in the same clinical setting. All patients were pre-stented for 3–5 days before URS. The study endpoint was stent-related symptoms as assessed by a validated questionnaire (USSQ). Results were stratified by clinical parameters, stone characteristics and operation details. 108 of 156 initially randomized patients undergoing ureterorenoscopy were included. USSQ scores covering the time 3–5 weeks after stone removal showed a significantly reduced urinary symptoms and pain index compared to the scores before ureterorenoscopy. USSQ results before and after stone removal did not correlate with stone size or operation time and did not differ significantly depending on stone localization, the treating endourologist, or ureterorenoscopic device used (p > 0.05). Six patients (5%) required reintervention. Following secondary ureterorenoscopy and ureteral drainage with a Mono-J for 6 h, quality of life is independent of stone size and localization, operation time, the treating endourologist, and the URS device used. Supplementary Information The online version contains supplementary material available at 10.1007/s00240-021-01264-4.

While a variety of techniques for in situ surgical renal stone removal have been described and used for decades (Gil-Vernet 1965; Smith and Boyce 1968; Gibbons et al. 1976), extracorporeal stone removal with subsequent autotransplantation of the kidney has had few proponents (Gil-Vernet et al. 1975; Flatmark et al. 1977; Gelin 1977; Novick 1981). The technique was first reported by Gil-Vernet and collaborators in 1975 for treatment of relapsing renal calculi. In our extensive experience with renal autotransplantation on various indications (Flatmark et al. 1989; Bondevik et al. 1990; Brekke et al. 1992), urinary calculous disease was the indication in approximately one third of the patients (Flatmark et al. 1989).

Percutaneous cholecystostomy for the removal of gallstones is used as an alternative to cholecystectomy in patients with calcified gallstones. The advantage of the technique is that all gallstones are removed immediately, regardless of composition, size or number of calculi [1–3]. It may also be used to complete the process of stone removal immediately after ECSWL of gallstones and to prevent stone fragments from passing into the bile ducts.

Since the early 1980s several teams have worked on the problem of fragmenting gallstones by laser [1–6]. The first successful endoscopic-retrograde laser fragmentation of a bile duct stone was reported in 1986 [7]. In the meantime, experiences by other teams in clinical laser lithotripsy of bile duct stones have been published [8–10] or reported on (N. Marcon and C. Haber 1989, M. Haws 1989, A.R.W. Hatfield 1989, and T. Ponchon 1989, personnal communications). However, to date, only about 50 patients have been treated with this new therapy method worldwide. The success rate (complete/partial stone removal) is estimated at 50%–80%. Complications after laser lithotripsy have so far not been reported.

Three access routes to the biliary tract are available for instrumentation: retrograde via gastrointestinal endoscopy, antegrade through the liver parenchyma, or through a postoperative drain tract. The latter two procedures involve interventional radiologic techniques in a transhepatic or subhepatic fashion.

Shortly after Fernstrom [1, 2] described the first percutaneous stone removal, a urologist, Dr. Arthur Smith, and a radiologist, Dr. Robert Miller, started the systematic percutaneous removal of renal calculi at the University of Minnesota. Due to the close cooperation between cardiovascular radiologists and urologists, numerous new techniques were developed.

The scattering of stone fragments throughout the kidney is an annoying complication of intrarenal stone disintegration and the main reason for residual calculous material after percutaneous nephrolithotripsy. Theoretically, a coagulum formed around the stone prevents the dispersal of the fragments and facilitates complete stone removal (Fig. 1a-d). Attempts to adapt techniques of coagulum pyelolithotomy for this purpose failed because all clots formed of blood derivates carry a high risk of pulmonary embolism and clotting disorders when applied percutaneously [3, 5]. These problems are avoided if the calculus is coated with a thermolabile gelatin during disintegration.

In 1941, RUPEL and BROWN utilized a nephrostomy tract established by open surgery for endoscopic inspection of the kidney with a cystoscope and extraction of small, obstructing calculi. In the following decades the technique was used sporadically to remove calculi which had been left behind during stone surgery (ENGELKING and ALBRECHT 1969; BRANTLEY et al. 1974; BISSADA et al. 1974; HARRIS 1975), or to remove stones which had formed around permanent nephrostomy tubes (RATHERT et al. 1977; KURTH et al. 1977). Nephrostomy tracts placed at open surgery are, however, usually curved and enter the collecting system at unfavorable positions for reaching calculi, especially if the stones had not been found at the time of surgery. The applicability of this method therefore remained restricted to some anectodal cases. Although GOODWIN et al. had already described a technique of percutaneous nephrostomy providing a straight tract to the kidney in 1955, it was not until two decades later that FERNSTROM combined the two methods to a systematic approach to percutaneous removal of kidney stones without the need for open surgery (FERNSTROM and JOHANNSON 1976). He reviewed this development in detail in his classical article on “Percutaneous puncture nephrostomy and stone removal” (FERNSTROM and ANDERSSON 1977).

Pyeloscopy or nephroscopy should define the direct inspection of the intrarenal system. If perfected, this technique would facilitate in a spectacular way intrarenal surgery for complete stone removal.

There is no debate about today’s strategy in the treatment of small pelvic or cali-ceal calculi: extracorporeal shock wave lithotripsy (ESWL) is the procedure of choice, and percutaneous nephrolithotomy (PNL) or surgery are only performed in rare cases (Fig.1). The situation is less clear for staghorn stones for several reasons. There is no solitary new procedure that guarantees success rates identical to those achieved in small calculi. Success and residual stone rates for PNL, ESWL or combined procedures are not easy to predict even during the multiple sessions sometimes necessary for complete stone removal. Finally, staghorn stones are so varied in shape and intrarenal location that it seems to be impossible to successfully apply only one or two techniques with consistently good results in large series covering the whole spectrum of staghorn stones.