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• W3128201681 abstract "This quote by Taguchi [ [1] Taguchi Y. Management of urinary calculi: update. Can Med Assoc J. 1970; 102: 3 Google Scholar ] was extracted from a 1970 publication. It illustrates well how common urinary stones are. Nearly all urologists have to deal with patients suffering from urinary stones in daily practice. Now, 50 yr later, what progress has been made? In the 1970s, stone extraction meant open surgery in most cases. Extracorporeal shockwave lithotripsy (SWL) and endourology (percutaneous nephrolithitomy and ureterorenoscopy) have changed significantly stone interventions and made them minimally invasive. For endourology approaches, the development of potent laser lithotripters was a major reason for the advances. Today, the holmium:YAG (Ho:YAG) laser is the gold standard despite some new and interesting technologies on the horizon, and an understanding of the physical principles of laser operation is a high priority. Last-generation systems involve a wide range of parameters to choose, such as the energy, frequency, pulse length, and pulse shape, with the highest variability found in expensive high-power lasers. But do we need all we can have, or are cost-effective, low-power lasers still sufficient for the majority of cases? In this issue of European Urology Focus, De Coninck et al and Emiliani and Angerri discuss the pros and cons of both concepts. Although the availability of modern laser technologies for stone disintegration allows minimally invasive endoscopic approaches, even for larger stones, other risks such as intrarenal pressure have to be considered, particularly for long ureteroscopy procedures or when using miniaturized percutaneous approaches. Appropriate access sheaths and irrigation flow pressures and rates are important aspects, as discussed by Doizi et al. Endourology has not reduced the frequency of double-J ureteral stenting in the perioperative management of urolithiasis; on the contrary, it seems to be standard in many centers before and after ureteroscopy. Nevertheless, tolerability is often low, with up to 80% of patients experiencing significant morbidity [ [2] Joshi H.B. Stainthorpe A. MacDonagh R.P. Keeley Jr., F.X. Timoney A.G. Barry M.J. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol. 2003; 169: 1065-1069 Crossref PubMed Scopus (363) Google Scholar ]. Research on new materials and adjunctive medication have had only a limited effect, which is why clinicians should critically consider the need for stent placement in each individual case, as described in the clinical consultation guide by Bibby et al." @default.
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• W3128201681 date "2021-01-01" @default.
• W3128201681 modified "2023-09-25" @default.
• W3128201681 title "Urolithiasis: Medical and surgical treatment" @default.
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• W3128201681 doi "https://doi.org/10.1016/j.euf.2021.01.013" @default.
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