Alberto Budía, chief of urology at La Fe University and Polytechnic Hospital, Valencia, Spain, and a member of the board of directors of the Spanish Association of Urology (AEU) reviewed the technological advances that have improved his approach.

The management of kidney stones has undergone one of the most radical transformations in all of urology. For centuries, “the only option was open surgery: bloody procedures with significant complication rates and weeks of recovery. The turning point came in the 1980s with the introduction of extracorporeal shock-wave lithotripsy (ESWL), which revolutionized treatment by offering for the first time a noninvasive alternative to break stones from outside the body,” Budía told El Médico Interactivo on the occasion of the 35th National Meeting of the Lithiasis and Endourology, Laparoscopy and Robotics Groups, held in Murcia, Spain.

At the same time, the development of endourology has allowed intraluminal access with ever-finer instruments, first with rigid ureteroscopy and later flexible ureteroscopy, also known as retrograde intrarenal surgery (RIRS), which can reach virtually any location within the renal collecting system. Percutaneous nephrolithotomy, which is indicated for large or very hard stones, has also been progressively miniaturized (mini-perc and ultra-mini-perc), reducing surgical trauma without sacrificing efficacy. What used to require invasive surgeries, long hospital stays, and painful recoveries can now often be resolved with minimally invasive techniques that have completely transformed the patient experience.

Historically, urinary stone disease has been reported more frequently in men, affecting men two to three times more often than women. However, Budía noted that “this gap has narrowed substantially over the last decade, especially among young women and adolescents, in parallel with increases in obesity, sedentary lifestyles, and metabolic syndrome. In Spain, available data place the national average prevalence at around 5%, with an incidence of approximately 325,000 new cases annually.”

Risk Factors

Kidney stone disease has a multifactorial etiology. Among metabolic and systemic risk factors, arterial hypertension, type 2 diabetes, obesity, and dyslipidemia are notable. “This has led specialists to regard it not only as a urinary disorder but as a systemic metabolic disease with organ repercussions. Idiopathic hypercalciuria is the most common metabolic cause, present in up to 35% of cases.”

Regarding dietary and lifestyle factors, low fluid intake is the dietary factor most consistently associated with stone formation. High intake of sodium and fructose increases risk, while maintaining a balanced diet is the best option to avoid stone formation.

From a genetic standpoint, the specialist recalls that a significant percentage of patients have a hereditary predisposition, especially in monogenic forms such as cystinuria or primary hyperoxaluria.

He also mentioned environmental factors, such as warm and dry climates that promote dehydration and concentrated urine, which is why stone disease is more prevalent in regions with higher temperatures. Finally, certain medications — including triamterene, sulfonamides, some anticonvulsants, and carbonic anhydrase inhibitors — can promote crystal formation.

Recurrence

Urolithiasis has a recurrence rate of between 30% and 50% over 5 years, making it a chronic condition for a significant number of patients. According to the Spanish Association of Urology (AEU), 1 in 10 Spaniards will develop kidney stones, with a recurrence rate of 50% in the 10 years following the first episode.

As Budía noted, prognosis varies according to stone type, the patient’s metabolic profile, and adherence to preventive measures. Calcium oxalate stones, which account for more than 80% of cases, have a high tendency to recur if predisposing factors are not corrected. Uric acid stones, on the other hand, can be dissolved with urinary alkalinization. Preventive treatments based on adequate hydration and individualized dietary adjustments according to stone type have been shown in some recent meta-analyses to reduce recurrences by up to 50%.

Beyond the acute pain of renal colic, recurrent kidney stones can be associated with progressive decline in renal function, recurrent urinary tract infections, and, in severe cases, chronic kidney failure.

Technological Advances

Advances in technology over recent decades have resulted in fundamental changes: Many cases are now resolved with endoscopic techniques that allow discharge within 24-48 hours, or even on an outpatient basis, with a marked reduction in complications and a much faster return to normal life.

Among the most relevant current techniques, the specialist highlights laser fragmentation via RIRS, which allows access to the inside of the kidney and pulverization of stones in any location in a single surgical act, with minimal tissue trauma.

Likewise, “mini-perc and ultra-mini-perc have expanded therapeutic options by significantly reducing complications and facilitating faster recovery. Advances in laser technology, such as the thulium fiber laser, offer greater efficiency and improved fragmentation quality with enhanced safety,” Budía detailed, adding that ESWL has also evolved technologically. Burst wave lithotripsy is emerging as a promising option that overcomes limitations of classic ESWL by improving fragmentation quality with minimal impact on adjacent tissue, and it is already being explored within the scientific community of the AEU’s specialized working groups.

AI in Stone Disease

AI is also making a strong entrance into the comprehensive management of kidney stones. In diagnostic imaging, “deep-learning algorithms have shown high accuracy in detecting and characterizing stones on CT and ultrasound, including estimating stone composition before intervention and directly guiding therapeutic choice,” the urologist said.

For risk and recurrence prediction, AI-based models have demonstrated a strong ability to identify patients at higher risk of developing stones or suffering recurrence, enabling more proactive and personalized interventions.

When planning surgery, Budía emphasized that “AI applied to predicting success in lithotripsy is one of the priority scientific topics on the agenda of the AEU’s specialized working groups, and it is beginning to be integrated into preoperative decision-making.”

Moreover, integrating AI with endourologic navigation systems and robotics promises greater intraoperative precision in real time.

Budía reported having no conflicts of interest.

This story was translated from El Médico Interactivo, part of the Medscape Professional Network.