New Devices for Kidney Stone Management

Russell S. Terry; Patrick S. Whelan; Michael E. Lipkin

Disclosures

Curr Opin Urol. 2020;30(2):144-148. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The purpose of this review is to summarize recent developments in the array of devices which are commonly used by urologists in the surgical management of kidney stones. To accomplish this goal, an extensive review of recent endourology literature, conference abstracts, and publicly available documents from manufacturers and the United States Food and Drug Administration was collected and reviewed.

Recent findings: Recent developments in the holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy include the introduction of pulse modulation. This technique delivers the laser energy in an asymmetric manner such that an initial bubble is created (the 'Moses effect') through which the remainder of the energy can then travel through without being absorbed by surrounding water. Even more novel is the thulium fiber laser, which is produced in a fundamentally different way than traditional Ho:YAG lasers and is not yet available for clinical use. Finally, novel mechanical lithotrites which effectively combine ultrasonic energy, ballistic energy, and suction capability appear to be highly effective for stone clearance in recent benchtop and clinical studies.

Summary: With the introduction of both new modifications of time-tested technologies as well as completely novel modalities, the practicing urologist's armamentarium of devices for the surgical management of kidney stones continues to grow. As the popularity of 'mini' procedures continues to grow, the adaptability of these technologies to these procedures will be critical to maintain maximum relevance.

Introduction

Since the first description of the original flexible ureteroscope by Marshall,[1] the field of endourology has experienced a golden era of rapid advances in surgical technique and procedures which have profoundly improved our ability to provide safe and efficacious care to our patients. At the core of our ability to sustain these advances is the ingenuity and dedication within the specialty to researching and developing the novel technology which has been necessary to advance the practice. The present era is no exception to this trend as clinicians, researchers, and industrial partners alike continue to strive together in concert to miniaturize, digitize, modulate, and otherwise enhance the tools in our surgical armamentarium. The past 2 years have been especially busy in the realm of new devices for kidney stone management as endourologists have witnessed the introduction of the next-generation versions of both laser lithotripsy devices as well as mechanical lithotrites. Even further out on the horizon, but not available for widespread clinical use yet, loom promising new innovations such as burst wave lithotripsy[2] and robotic ureteroscopy[3] which hold still more potential for advancing the field.

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