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Stone metrics: is stone volume the new king?
Charlotte Slots1, Matthias Boeykens1,2, Kim Pauwaert1,3
1Department of Urology, Ghent University Hospital, Ghent.
Current Opinion in Urology
|March 14, 2026
Summary
Stone volume is a more accurate measure of kidney stone burden than linear measurements. Despite technological advances making volume assessment easier, it is not yet standard clinical practice.
Area of Science:
- Urology
- Medical Imaging
- Nephrology
Background:
- Stone volume is the most accurate metric for urolithiasis burden.
- Linear measurements are currently standard but have limitations.
- Stone volume is not yet integrated into clinical practice or treatment guidelines.
Purpose of the Study:
- To review evidence supporting stone volume as the most important stone metric.
- To evaluate the current clinical utility of stone volume assessment.
- To highlight the need for incorporating stone volume into treatment algorithms.
Main Methods:
- Literature review of studies comparing stone volume to linear measurements.
- Analysis of recent advances in imaging and artificial intelligence for stone volume assessment.
- Evaluation of stone volume's predictive accuracy for treatment outcomes.
Main Results:
- Stone volume accurately predicts stone-free status after shockwave lithotripsy and ureteroscopy.
- Advances in 3D imaging, automated segmentation, and AI facilitate stone volume calculation from CT scans.
- Despite improved accessibility, stone volume assessment is underutilized in clinical practice.
Conclusions:
- Technological barriers to stone volume assessment have been overcome.
- Widespread adoption of stone volume in clinical practice is hindered by resistance to change.
- Further research is needed to establish volume-based treatment thresholds and develop new algorithms.
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