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Open research questions in Kidney Stones and Urolithiasis Treatments

39 unresolved questions extracted from the limitations and future-work sections of 529 Kidney Stones and Urolithiasis Treatments papers in our library. Each links back to the study that raised it.

What the literature leaves open

  •  Books (/booksbrowse)  ®  The lower infection rates after reimplantation must be balanced against potential long-term consequences, including difficulty with retrograde ureteral instrumentation after crosstrigonal repair (which may not be applicable to other intravesical techniques such as Politano-Leadbetter or Glenn-Anderson) and bladder dysfunction risk after bilateral …

    Comparative Analysis of Ureteral Reimplantation and Dextranomer/Hyaluronic Acid Injection Between Two Centers with Systematic Review and Meta-Analysis · 2026 · DOI

  • Because the survey was distributed through social media platforms, scientific meetings, professional networks, and the EAU Endourol- ogy Section, the total number of individuals reached could not be determined and a response rate could not be calcu- lated.

    Comprehensive survey on urological stent practices by the European Association of Urology (EAU) Endourology · 2026 · DOI

  • lithotripsy. These and prophylaxis incorporate algorithms the need laser that to laser systems the pace of Дослідницька стаття / Research article individualised care, which considers the characteristics of stones, patient anatomy, comorbidities, and patient preferences. However, technological development and growing scientific understanding still puts prevailing paradigms to the test, and best practises have to be re-evaluated on a regular basis. Regardless of these developments, there is still a lot of variability in clinical practise and there are still gaps in evidence to practice translation. Availability of modern technologies shows geographical inequality, and compliance with preventive measures is not optimal. Moreover, the rate of innovation, especially in imaging technology, and digital health applications, has surpassed the capability of the traditional reviews to present an integrated and up-todate synthesis of the field. The modern, technology-based review of renal stone disease, however, is justified by the necessity to critically assess and frame recent diagnostic and therapeutic advances in the context of patient-centred care. Such a review can guide clinical decision-making and point to future research areas through the synthesis in trends, of changing knowledge, pathophysiological management approaches. This review is, therefore, aimed at giving a detailed account of the modern urological assessment of renal stone disease, the improvements in treatment and diagnosis, and new paradigms that are transforming the management of this disease, which is becoming more common.

    Modern Urological Approaches to Renal Stone Disease: Diagnostic Advances and Therapeutic Innovations · 2026 · DOI

  • The resulting variability and lack of standardization in PN practices ultimately prompted us to investigate urologists' perspectives on this topic.

    Percutaneous Nephrostomy Experience Among Urologists in Türkiye · 2026 · DOI

  • At our institution, SMS reminders are routinely sent to patients to alert them of upcoming appointments; however, in this case, the patient's international travel and change of contact availability rendered this measure ineffective, highlighting that reminder systems alone are insufficient without a dedicated ureteral stent registry in which all insertions are logged with scheduled 2026 Buali et al.

    Bilateral Obstructive Uropathy Requiring Hemodialysis With Presumed Spontaneous Stone Clearance After Two Years of Forgotten Ureteral Stents: A Case Report · 2026 · DOI

  • Prospective, randomized trials with larger cohorts and longer follow-up are warranted to confirm these findings and to better define the ideal patient and stone characteristics for this promising approach. Although our study follow-up is mid-term, this functional data is promising and warrants investigation in longer-term studies.

    Comparison of vacuum-assisted flexible ureteroscopy and percutaneous nephrolithotomy for 2–3 cm upper tract stones: a real-world cohort study · 2026 · DOI

  • Abstract Three-dimensional (3D) rendering of urologic pathology plays an important role in simulation-based education, surgical training, and computer vision research; however, a standardized, open-access repository of high-fidelity kidney stone models stratified by chemical composition is lacking.

    A validated custom pipeline for three-dimensional kidney stone renderings tocreate an open access repository · 2026 · DOI

  • This study has several limitations. First, it was conducted at a single tertiary referral center, which may limit generaliz- ability—particularly since such centers may encounter more complex stone disease. Second, although prospective data collection improves reliability, this study design remains observational and cannot establish causality. Third, follow- up imaging for stone-free assessment was based on KUB and selective delayed ultrasonography rather than uniform non-contrast CT, which may underestimate small residual fragments. Fourth, some anomaly subgroups (e.g., horse- shoe kidney, infundibular stenosis) had limited sample sizes, restricting the power for subgroup analysis. Finally, techni- cal variations between surgeons—although minimized in a specialized center—could have contributed to differences in outcomes. Differences in skill between surgeons are accept- able and not included in this study. We acknowledge that some of these anomalies may be considered anatomical variants with limited clinical impact on PCNL outcomes. We are aware of the differences between methods of SFR evaluation. Heterogeneity in imaging modalities is a limita- tion but the reasons for this are the conditions of patients’ access to various imaging methods and the consideration of minimum additional costs. There was lack of blinding in our study.

    Percutaneous nephrolithotomy among patients with upper urinary system anomalies: evaluating the prevalence, types, characteristics and comparing its outcomes with other patients: a prospective, comparative study of 1485 patients · 2026 · DOI

  • The primary strength of this systematic review and metaanalysis lies in its strict inclusion criteria, which were limited exclusively to RCTs. By excluding retrospective and observational cohorts, we significantly minimized selection bias and baseline confounding factors that mainly influenced previous meta-analyses [19, 70]. Furthermore, our study included the largest and most up-to-date RCTs (30 studies, 4173 patients), capturing recent technological advancements such as high-power thulium fiber lasers and flexible navigable suction sheaths. We also conducted clinically relevant subgroup analyses, particularly according to stone location and pre-stenting status, to provide a more detailed assessment of the available evidence. The application of TSA further strengthens our methodology by confirming that the cumulative evidence for SFR is sufficient and conclusive. For our primary efficacy outcome, the TSA cumulative Z-curve for the single-session SFR definitively crossed both the conventional and trial sequential monitoring boundaries. This confirms that the current cumulative evidence is robust and sufficient to establish the superiority of mPCNL in achieving complete stone clearance, ensuring that future trials are unlikely to alter this specific consensus. Regarding overall complication rate, TSA findings should be interpreted cautiously. Although the cumulative Z-curve crossed the conventional and trial sequential monitoring boundaries, the required information size was not reached, and the pooled meta-analysis itself did not show a statistically significant difference. Therefore, the safety findings should be interpreted with caution in light of the substantial heterogeneity. Despite the use of a random-effects model, leave-one-out sensitivity analysis, and selected subgroup analyses, substantial unexplained heterogeneity remained in the single-session SFR outcome, which should be considered when interpreting the pooled efficacy findings. A key strength of this review is the incorporation of a GRADEbased certainty assessment, which enabled transparent interpretation of the confidence in effect estimates across the seven most clinically important outcomes. Despite these methodological strengths, several limitations must be acknowledged. First, there was inherent heterogeneity among the included RCTs regarding surgical techniques, laser settings, and the specific caliber of the miniaturized nephroscopes which was used (10 Fr to 22 Fr). Second, the definition of stone-free was different across trials.

    Retrograde intrarenal surgery versus miniaturized percutaneous nephrolithotomy for renal calculi: a grade-assessed meta-analysis of randomized controlled trials with trial sequential analysis · 2026 · DOI

  • ruit ingested could not be determined retrospectively, as the patient was unable to recall the precise quantity beyond describing it as “several dried fruits.

    An Unusual Cause of Oxalate Nephropathy: Acute Kidney Injury After Ingestion of Dried Bilimbi Fruit · 2026 · DOI

  • A limitation of the present study is that stone detection performance was not fully stratified by anatomical stone location, such as the kidney, ureter, or bladder. Because both anatomical location and the presence of radiopaque stents may influence detection difficulty on KUB radiographs, these factors should be examined in future work using predefined subgroup analyses.

    Artificial intelligence for radiographic detection of urinary stones in resource-constrained settings · 2026 · DOI

  • complexity recommendations proposed by the author’s team based on mechanism understanding, aiming to provide a systematic reference for the safe and effective implementation of suction assisted ureteroscopy surgery. Successful use of suction during ureteroscopy with a suction sheath will depend on how well you can manage the three components of the “Fluid-Energy-Tissue” triangle and the relationship they have to each other. The fluid component refers to the flow of irrigation, which must provide stable visualization and heat adequate dissipation (the ability to remove heat generated from the laser). Energy delivery must be managed in relation to the systems’ clearance capacity. Tissue management must also be carefully managed due to the in accessing the ureters. it would be reasonable to develop a plan for Therefore, preoperative evaluation of your patient using two intersecting axes, physiological susceptibility, so that suction may be applied in areas that are most likely to have a high degree of success in terms of providing active removal of debris as part of the procedure. The clearance complexity of a stone is generally determined by the size of the stone burden, specifically those larger than the maximum diameter possible for passage through the ureter, and the number of stones present (multiples) and their location within the renal collecting system (calyx) (8, 68, 69). Stones located in the lower pole of the kidney have anatomical characteristics that favor the sedimentation of particles in the dependent aspect of the stone bed and create a mechanical disadvantage for maneuverability of instruments in the lower pole and the ureteroscope. The expected fragility or type of stone, which is assumed based on the expected quantity of stone fragments produced by lithotripsy, determines if the procedure is going to be limited by the amount of particulate matter being produced rather than the actual rate at which stone fragments are created (70, 71). Susceptibility is determined by the patient’s history of obstruction, hydronephrosis, previous instrumentation, current urine culture results, current levels of systemic inflammatory markers, and past medical history that indicates colonization of sustained deflection of the potential for the stones, because all of these factors increase the severity of the consequences of increased intrarenal pressure and prolonged exposure to contaminated effluent. A third filter that must be evaluated concurrently is the feasibility of access to the ureter(s), since non-traumatic placement of the sheath can convert an optimization process the patient’s ureteral caliber, suspected stricture, prior ureteral surgery, and stent history should guide a low threshold for a the decision ureteroscopy or stage the ureteroscopy if significant resistance is met during advancement of the ureteroscope.

    Research progress on treating urinary system stones using ureteroscopy combined With a negative-pressure suction sheath · 2026 · DOI

  • YOLOv8 exhibited diminished sensitivity for detecting very small stones (<1.5 mm), especially those obscured by anatomical noise or located near vascular structures.

    Urological diagnostics based on kidney stone detection in CT imaging using YOLOv8 deep learning framework · 2026 · DOI

  • 11 The rational evidence remains to be investigated; however, increased obesity,4,11 change of diet and lifestyle,4,43 and utilisation of imaging technology could be reasons for this observation. Despite the international administrative data we used in our analyses, we lacked data in many regions, including sub-Saharan Africa, Australasia, south Asia, Andean Latin America, and eastern Europe.

    The global, regional, and national burden of urolithiasis in 204 countries and territories, 2000–2021: a systematic analysis for the Global Burden of Disease Study 2021 · 2024 · DOI

  • Further prospective studies and randomized clinical trials are warranted to confirm these findings and clarify the underlying mechanisms.

    Comparative Risk of Kidney Stone Formation Between SGLT2 Inhibitors and DPP-4 Inhibitors in Diabetic Patients : Systematic review and Meta-Analysis · 2026 · DOI

  • However, intraoperative physiological and anesthetic events during the procedure remain poorly characterized, particularly in the context of newer technologies such as suction-assisted systems.

    Safety Profile of Suction-Assisted RIRS: A Prospective Analysis of Intraoperative Anesthetic Events · 2026 · DOI

  • Results from an online questionnaire revealed that although most respondents had limited knowledge of kidney stones, they expressed strong interest in, and a willingness to pay for, a convenient, accurate, and safe online detection system.

    Exploring the Potential of an Online Kidney Stone Detection System: A Mixed Methods Study in Patients and Healthy Individuals · 2026 · DOI

  • Its etiology is not fully understood but may involve congenital wall abnormalities, chronic inflammation, elevated pressure secondary to urinary obstruction, or trauma (5).

    Case Report: Spontaneous dissection of the renal pelvis and ureter · 2026 · DOI

  • Although the exact mechanism is not fully understood, it may work by increasing urine output and decreasing the concentration of stone-forming substances in the urine.

    To Evaluate The Pharmacological Activity Of 'Bryophyllum Pinnatum' On Ethylene Glycol Induce Urolithiasis In Rats. · 2026 · DOI

  • Effective discrimination between true calculi and confounding features, such as high-attenuation artifacts, is essential for reducing false alerts and maintaining clinician confidence in automated systems.

    Urological diagnostics based on kidney stone detection in CT imaging using YOLOv8 deep learning framework · 2026 · DOI

  • However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community.

    Modern Methods of Treatment for Proximal Ureterolithiasis · 2021 · DOI

  • To date, however, few studies have analyzed the possible renal trauma generated by PCNL tract dilation.

    Renal parenchyma injury after percutaneous nephrolithotomy tract dilatations in pig and cadaveric kidney models · 2017 · DOI

  • CONCLUSION: So far, the association between serum gonadal steroids and urolithiasis in males received only limited attention and the recommendation for steroid investigation as a basic evaluation to rule out treatable systemic causes in urolithiasis patients is warranted.

    DETERMINANT ROLE OF GONADAL SEX HORMONES IN THE PATHOGENESIS OF UROLITHIASIS IN A MALE SUBJECT – A DOCUMENT FOR MALE PREDOMINANCY (CASE STUDY) · 2010 · DOI

  • Among the studied factors, male gender with a three times higher incidence of urolitlithiasis than female gender is considered as a risk factor, but the influence of sex hormones on urinary stone formation remains undetermined.

    DETERMINANT ROLE OF GONADAL SEX HORMONES IN THE PATHOGENESIS OF UROLITHIASIS IN A MALE SUBJECT – A DOCUMENT FOR MALE PREDOMINANCY (CASE STUDY) · 2010 · DOI

  • Since the association between serum testosterone and urolithiasis has yet received only limited attention, the pathogenesis of this male predisposition still remains to be elucidated and thus the reason for this male predominance remains apparently obscure.

    DETERMINANT ROLE OF GONADAL SEX HORMONES IN THE PATHOGENESIS OF UROLITHIASIS IN A MALE SUBJECT – A DOCUMENT FOR MALE PREDOMINANCY (CASE STUDY) · 2010 · DOI

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39 open questions have been extracted from the limitations and future-work passages of 529 Kidney Stones and Urolithiasis Treatments papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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