Future of kidney stone surgery: will we treat small stones with large-sized PCNL and big stones with RIRS?

Excerpt

For many years endourologists are searching for the most efficient and least traumatic stone treatment. More and more miniaturized instruments and innovative stone disintegration tools are continuously expanding our armamentarium [1, 2]. Meanwhile, currently available modern imaging modalities are able to detect more and smaller residual fragments postoperatively. In that way, the average stone-free rates are decreasing dramatically despite our new sophisticated treatment options [3]. Dealing with this dilemma we have to take into consideration that in first-time stone formers complete stone-free status seems to be of uttermost importance since even residual fragments smaller than 4 mm could be responsible for acute symptoms in the future [4‐6]. But what are the possibilities to offer the best solution to our patients? Which technologies fit the need for the least traumatic but most efficient procedure in stone surgery? …