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Stone fragmentation in percutaneous surgery: is there a paradigm shift?
Stefano Schininà1,2, Attilio Barretta1, Riccardo Schiavina1
1Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Current Opinion in Urology
|March 31, 2026
Summary
Recent advances in percutaneous nephrolithotomy (PCNL) favor laser fragmentation and active suction for kidney stones, improving efficiency and safety over traditional methods. This shift enhances operative outcomes without compromising stone-free rates.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Percutaneous nephrolithotomy (PCNL) is the standard for large kidney stones.
- Traditional PCNL uses mechanical lithotripsy and manual extraction.
- Advances in technology prompt a re-evaluation of PCNL techniques.
Purpose of the Study:
- To assess if new PCNL technologies represent a paradigm shift or refinement.
- To review advancements in stone fragmentation and evacuation.
- To compare traditional versus contemporary PCNL approaches.
Main Methods:
- Review of recent literature on PCNL technologies.
- Analysis of fragmentation and evacuation techniques.
- Comparison of laser-based vs. mechanical lithotripsy.
Main Results:
- Transition towards laser fragmentation (holmium:YAG, thulium fibre) in miniaturized PCNL.
- Suction-enabled sheaths allow simultaneous fragmentation and active evacuation.
- Laser and suction systems show comparable stone-free rates with improved efficiency and safety.
Conclusions:
- PCNL is shifting towards laser dusting and active aspiration.
- This evolution prioritizes efficiency and safety over solely stone-free rates.
- Wider adoption requires addressing cost, availability, and training needs.
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