Urology · Kidney stones
What is actually new in kidney stone surgery
Stone surgery has changed genuinely in the last few years — but not in the way the marketing suggests. The real shift is not a sharper laser. It is suction: clearing fragments out of the kidney while the surgeon works, instead of leaving them to pass on their own.
The short answer
- Suction is the real advance. New sheaths and instruments remove stone fragments as they are created, so fewer are left behind.
- Lasers have improved, and the thulium fiber laser dusts stones finely. But head-to-head evidence that it changes how patients actually do is still maturing.
- Faster and cleaner is not automatically safer. A large 2025 multicentre study found a technique with better stone clearance also had more bleeding and organ injuries.
- None of it stops stones coming back. Prevention is still done with blood tests, urine tests and diet — at home, not in an operating theatre.
1. Suction: clearing the kidney as the surgeon works
In traditional stone surgery the stone is broken up and the pieces are either collected one by one with a basket, or left to wash out in the urine over the following weeks. Fragments that stay behind are the main reason a stone "comes back" within a year — often it never left.
The newer instruments apply gentle continuous suction inside the kidney. In flexible endoscopy this means a suction access sheath that can be steered into different parts of the kidney; in keyhole surgery it means suction mini-PCNL, where the fragments are drawn out through the same narrow tract used to break them.
Beyond clearing fragments, suction helps with two things patients never hear about: it keeps pressure inside the kidney lower, and it carries away the heat generated by the laser. Both matter, because high pressure is linked to infection spreading into the bloodstream after surgery.
2. Lasers: better, but read the claims carefully
For years the holmium laser was the standard. The thulium fiber laser is newer and delivers energy in a way that produces very fine dust and pushes the stone around less, which makes some operations more controlled.
The thulium fiber laser is a real engineering improvement, and many high-volume surgeons prefer it. What is not yet settled is whether it leaves patients meaningfully better off — higher stone-free rates, fewer complications, fewer repeat procedures — compared with a well-performed holmium operation. Studies are ongoing.
If a centre presents its laser as the reason to choose it, that is a marketing claim, not a clinical one. The instrument matters less than who is holding it and whether the whole stone gets cleared.
3. The trade-off nobody puts in the brochure
A 2025 multicentre study run through the European Association of Urology's endourology section compared two ways of breaking stones during suction mini-PCNL across 30 centres. After careful statistical matching of 748 patients, the results were clear in both directions.
| Non-laser (ballistic / ultrasonic) | Laser | |
|---|---|---|
| Time spent breaking the stone | 12 min | 18 min |
| Total operating time | 37 min | 45 min |
| Stone cleared during surgery | 91.3% | 80.7% |
| Stone-free at 30 days | 87.7% | 82.1% |
| Blood transfusion | More often | Less often |
| Injury to the kidney's collecting system or chest lining | More often | Less often |
Faster, and more stone cleared — but paid for with more bleeding and more injuries. This is what an honest technology comparison looks like, and it is why the choice belongs to a surgeon who knows your anatomy rather than to a patient choosing from a website.
4. What none of this changes
- Small stones still often pass by themselves. Better technology is not a reason to operate on a stone that did not need an operation.
- No technique clears every stone every time. Ask about second sessions.
- Stones come back. Roughly half of stone formers form another within ten years unless the cause is found and addressed. That work is blood tests, urine tests, fluid intake and diet — and it happens where you live.
- Stone analysis is still the most useful test you can have after surgery, and the one most often forgotten.
What to ask a centre — instead of asking about the laser
- For a stone of my size and position, which operation do you recommend, and why that one?
- How often do patients with a stone like mine need a second session?
- Will I have a stent, and when will it be removed?
- Will my fragments be sent for stone analysis, and will I be given the result?
- What report will I take home for my own doctor?
"The newest machine gives the best result."
Across stone surgery, the factors that consistently predict a good outcome are the size and position of the stone, the anatomy of the kidney, and how many of these operations the surgeon does. Equipment matters — but it is the last of those four, not the first.
Medically reviewed by Assoc. Prof. Dr. Bekir Voyvoda
Urologist at Florence Nightingale Hospital, Istanbul; Associate Professor since 2025. This guide was prepared by the BookingHospital medical team from current urological literature and reviewed for surgical accuracy. Treatment for each patient is planned by the operating urologist after their own imaging is assessed.
Send your scan and we will tell you what is realistic
Send your CT report and recent blood and urine tests. A physician will review them and tell you which treatments are reasonable for your stone — including when waiting is the better answer.
Medical disclaimer. This article is general information based on published international guidelines and peer-reviewed studies. It is not personal medical advice, it does not establish a doctor–patient relationship, and it cannot replace assessment by the physician treating you.
References
- European Association of Urology. EAU Guidelines on the Diagnosis and Treatment of Urolithiasis. European Urology 2025.
- American Urological Association. Surgical Management of Kidney and Ureteral Stones: AUA Guideline, 2025.
- EAU Endourology Section multicentre study comparing laser and non-laser lithotripsy during suction mini-percutaneous nephrolithotomy, 2025.