A 24-hour urine collection is central to the metabolic evaluation and prevention of nephrolithiasis. Despite its widespread use, methodological inconsistencies in data reporting and analysis limit the reliability, reproducibility, and clinical utility of findings. We aim to review and evaluate how 24-hour urine parameters are reported, analyzed, and interpreted in nephrolithiasis research. We conducted a methodological review of 264 studies involving 450,624 patients with nephrolithiasis. Data extraction covered urine collection protocols, parameter reporting, units used, statistical methods, and missing data handling. Retrospective cohort studies comprised 42.8% of included articles; cross-sectional and prospective cohort studies made up 25.0% and 19.3%, respectively. Only 6.8% (18/264) of studies reported power calculations, and 40.9% (108/264) provided reference ranges. Calcium was the most frequently reported parameter (93.9%), followed by citrate (87.5%), oxalate (86.7%), and uric acid (84.1%). Supersaturation indices were reported in 44.3% of studies. Reporting formats varied: continuous units were used in 94.7% for supersaturation, 91.7% for calcium/creatinine ratio, and 77.9% for calcium. Most common units were mg/day (e.g., calcium: 78.9%) and mmol/day (e.g., sodium: 56.9%). Regarding statistical analysis, 72.3% of studies used t-tests or Mann-Whitney U tests, 39.4% used chi-square tests, and only 21.6% used multivariate regression. Missing data were handled by complete case analysis in 71.2% of studies, while 27.7% did not report their approach. There is significant variability in how 24-hour urine data are reported and analyzed across nephrolithiasis studies. This inconsistency undermines evidence synthesis, limits external validation, and obstructs the integration of advanced tools like artificial intelligence. We recommend creating a standardized reporting checklist to improve the rigor, reproducibility, and clinical relevance of future research.

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is the gold standard for ureteroscopic lithotripsy, but faces challenges such as stone retropulsion. The emerging thulium fiber laser (TFL) offers advantages, including higher efficiency, smaller fiber size, and reduced retropulsion. Our study aims to compare the stone ablation efficiency of TFL and Ho:YAG laser. This study is a prospective, single-center, randomized controlled trial comparing TFL and Ho:YAG laser for ureteral stone lithotripsy in 35 patients. The primary outcome is stone ablation efficiency, with secondary outcomes including total operation time and laser time, the degree of retropulsion, clarity of endoscopic view, hospital stay, 30-day complications, 3-month stone-free rate, and requirement for auxiliary procedure. The stone-free rate is defined as the absence of detectable stones on a post-operative noncontrast CT scan conducted 3 months after the procedure. Sixteen patients and 19 patients were randomized in the Ho:YAG group and TFL group, respectively. Patient demographics were comparable except for more men in the TFL group (81.3% vs 68.4%). The stone ablation rate (the volume of stone ablated per minute of laser time) was comparable between both groups (1.12 mm³/s for the TFL group and 1.33 mm³/s for the Ho:YAG group, p = 0.772). TFL had shorter laser time (3.02 vs 5.78 minutes, p = 0.013), less retropulsion (p = 0.048), and a higher stone-free rate (100% vs 78.9%, p = 0.0015). Lithotripsy using a thulium fiber laser achieves a stone ablation rate comparable to that of the holmium:YAG laser. The thulium fiber laser results in a higher stone-free rate while keeping complication rates similar.

While the da Vinci surgical system has dominated robot-assisted partial nephrectomy (RAPN), its high cost limits accessibility. The Revo-i surgical robot offers a cost-effective alternative with approximately 42% lower cost, but clinical experience in partial nephrectomy (PN) remains limited. This study provides the first clinical comparison of perioperative outcomes between Revo-i and da Vinci Xi systems for RAPN. This retrospective study included 124 patients who underwent RAPN between September 2023 and October 2025 at a single tertiary center. Patients were informed about both platforms, and the final system was selected through shared decision-making. Revo-i was preferentially used in patients with cost concerns and low- to intermediate-complexity tumors. Patients were treated using da Vinci Xi (n = 79) or Revo-i (n = 45) systems. Tumor complexity was stratified by R.E.N.A.L. nephrometry score into low (<7), intermediate (7-10), and high (>10) groups. The primary outcome was trifecta achievement (negative surgical margins, warm ischemia time [WIT] <25 minutes, and no complications). Baseline characteristics were comparable, although the Revo-i group had a lower R.E.N.A.L. score (7 vs 8, p = 0.004) and fewer hilar tumors (11.1% vs 35.4%, p = 0.003). Operative time, blood loss, and hospital stay were similar. No perioperative complications occurred. Overall trifecta achievement was 66.7% for Revo-i and 57.0% for da Vinci (p = 0.342). The percentage change in estimated glomerular filtration rate was similar between groups (-0.50% vs -0.49%, p = 0.410), with no significant differences across tumor complexity subgroups. In low-complexity cases, Revo-i showed shorter WIT (8 vs 17 minutes, p = 0.003) because of a higher rate of zero-ischemia cases (45.0% vs 9.5%, p = 0.015). In high-complexity cases, Revo-i showed longer WIT (50 vs 33 minutes, p = 0.005) and no trifecta cases. Revo-i demonstrates comparable outcomes with da Vinci Xi for low- and intermediate-complexity PN. However, caution is warranted for high-complexity cases because of prolonged WIT.

The Revised Cardiac Risk Index (RCRI) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) are well-recognized tools to predict 30-day postoperative cardiac events in noncardiac surgeries. However, their predictive accuracy is yet to be assessed in minimally invasive transurethral prostate surgery. We compared the RCRI- and NSQIP-predicted postoperative cardiac outcomes with the actual incidence of cardiac events after transurethral prostate surgery. We conducted a retrospective review of patients who underwent transurethral prostate surgery between July and December of 2022. We assessed for postoperative cardiac events within 30 days, as defined by the seminal cardiac VISION study. The RCRI and NSQIP cardiac event predictions were calculated. Fisher's exact test was used for analysis. We included 185 patients with an average age of 73 ± 8.4 (standard deviation) years, 86 of whom (46%) had transurethral resection of the prostate, and 99 underwent Holmium Laser Enucleation of the Prostate (54%). Myocardial injury after noncardiac surgery surveillance was needed for 34 patients (18.4%) as per standard practice. No patient had any intraoperative cardiac events. One patient experienced a nonfatal postoperative cardiac event (asystole) within hours of surgery. The 30-day cardiac event prediction by the RCRI was 4.8% of the patient cohort (n ≈ 9), significantly higher than the observed incidence of 0.5% (p = 0.0198). NSQIP predicted that 0.54% of the patient cohort (n = 1) will have a cardiac complication within 30 days, which is not significantly different from the observed cardiac event incidence (p = 1). The RCRI significantly overestimated the 30-day cardiac risk after transurethral prostate surgery, whereas NSQIP predictions and the observed rate of cardiac events were similar. Utilizing more representative predictive tools helps improve risk stratification and will allow patients and surgeons to make better-informed decisions.

To critically appraise the Radius, Exophytic/endophytic, Nearness of tumor to collecting system or sinus, Anterior/posterior, Location relative to polar lines (R.E.N.A.L.), Preoperative Aspects and Dimensions Used for an Anatomical classification (PADUA), and Radius, Position, iNvasion of sinus (RPN) nephrometry systems with respect to their classification of tumor complexity for surgical planning in robot-assisted partial nephrectomy (RAPN) and to compare their statistical validity, methodological rigor, and predictive performance. A structured synthesis of published evidence identified large multicenter series, prospective cohorts, and meta-analyses from 2009 to 2025 that evaluated the predictive accuracy, methodological design, and clinical relevance of these systems. Key evaluation domains included statistical validation, anatomical parameter selection, and correlation with surgeon-perceived difficulty in RAPN. Both the R.E.N.A.L. and PADUA scores were developed using empirically selected parameters and have historically been validated based on their correlation with perioperative outcomes. However, evidence in the literature now shows that such correlations are inconsistent and often clinically irrelevant in RAPN. In contrast, the RPN score was developed using a statistically modeled approach, reflecting the real-world surgical difficulty of RAPN as perceived by experienced robotic surgeons. Current evidence does not support the continued use of R.E.N.A.L. and PADUA scores as validated tools in RAPN. The RPN score, with its statistically validated, anatomy-based methodology and alignment with surgical difficulty, represents a scientifically superior and clinically practical alternative for standardizing tumor complexity in RAPN.

Robot-assisted nephrectomy and inferior vena cava (IVC) thrombectomy are technically demanding and high-risk procedures. The role of multidisciplinary team (MDT) management in robotic surgeries has not been reported previously. This study aimed to evaluate the safety and feasibility of MDT management in robot-assisted nephrectomy and IVC thrombectomy. We retrospectively analyzed 209 patients who underwent robot-assisted nephrectomy and IVC thrombectomy for renal tumor with venous tumor thrombus (Mayo levels I-IV) in our center between June 2013 and December 2023. Since July 2018, a proactive, comprehensive, and full-process MDT management framework has been implemented perioperatively. Patients were divided into MDT management (n = 142) and non-MDT management (n = 67) groups, with propensity score matching (1:1) resulting in 67 patients in each group. Multivariable regression, survival analyses, and interrupted time series analysis were conducted to assess perioperative outcomes and survival. All procedures were completed without conversion. MDT management significantly improved perioperative outcomes compared with the non-MDT group. Specifically, MDT reduced estimated blood loss (p = 0.045), intraoperative blood transfusion (p = 0.009), blood transfusion volume (p = 0.005), postoperative intensive care unit stay (p = 0.002), and postoperative hospital stay (p < 0.001). Multivariable regression confirmed that these improvements were independent of other factors. MDT management was associated with a significant improvement in overall survival (hazard ratio [HR] = 0.27, p = 0.023) and a potential benefit in progression-free survival (HR = 0.40, p = 0.065), as indicated by survival analysis. MDT management in robot-assisted nephrectomy and IVC thrombectomy improves perioperative safety and enhances survival outcomes. This study highlights the critical role of the standardized MDT framework we proposed in optimizing high-risk robotic procedures.

The FlexStone device (EndoTheia, Nashville, TN) is an investigational, steerable stone basket. The device provides additional flexion separate from the ureteroscope without an assistant. We evaluated the safety and feasibility of this new novel device for stone retrieval. In this first-in-human clinical trial, 10 patients underwent flexible ureteroscopy (URS) for renal calculi using the FlexStone device. The primary endpoint was the safe and successful basketing of renal stones with the device. Intraoperative and short-term postoperative adverse events were evaluated. Secondary endpoints included surgeon workload assessed by the National Aeronautics and Space Administration Task Load Index (NASA-TLX). The majority of patients had a solitary stone (60%) and stone was in the lower pole (90%) with a minority of patients also having stones in upper pole (20%) or interpolar region (10%). Median cumulative axial stone size was 11 mm (interquartile range [IQR]: 7.5-15.25 mm). The device was used to extract (60%) or reposition (40%) of stones. Surgeons used the FlexStone device to successfully basket target stones in 9 cases (90%). No intraoperative complications occurred. Postoperatively, one patient needed a second URS procedure for hydronephrosis, but no obstructing stone was seen. On the NASA-TLX scale from 1 (low) to 21 (high), the demand when using the device was low, with median mental demand-6 (IQR: 4-12), physical demand-9 (IQR: 6-12), temporal demand-6 (IQR: 4-6), and frustration-6 (IQR: 1-6). Surgeons rated the device with high overall performance (median 3, IQR: 3-8, perfect = 1). Our preliminary investigation demonstrates the safety of a new, unique steerable stone basket. The FlexStone device is a potentially valuable addition to the urologist's armamentarium, especially for complex caliceal anatomy and improving ergonomics when using URS.

Idiopathic calcium oxalate stone formers (ICSFs) are a heterogeneous group. Randall's plaque (RP) and ductal plugs are two common papillary features observed in ICSFs. These papillary phenotypes, implicated in early stone formation, may be susceptible to different risk factors and have differing long-term health outcomes such as stone events and kidney function. We investigate these outcomes using clinical data from a well-characterized cohort of ICSFs undergoing endoscopic stone removal. ICSFs undergoing stone removal procedures were consented for the study between August 2005 and May 2023. Papillae were imaged endoscopically per standard protocol. Two 24-hour urine tests were collected postoperatively while patients were off stone prevention medications. Chart review was performed for comorbidities, serum laboratories, and medication usage related to stone formation. We identify three distinct phenotypes. Of 106 ICSFs, 37 had high plugging without plaque, 44 had high plaque without plugging, and 25 had low plaque and low plugging. High plugging ICSFs had lower estimated glomerular filtration rate (eGFR), increased history of prior urinary tract infection (UTI), and more prior stone events than ICSFs with high plaque or neither feature. Multivariable regression revealed plugging as a significant predictor of eGFR when correcting for age, gender, prior UTIs, and prior stone events. Plugging appears to be an important predictor for eGFR and multiple stone events. Prior UTIs appear to have a significant effect on plugging. RP did not appear to influence stone events or kidney function.

To develop an interpretable machine learning (ML) model for predicting surgical outcomes in renal hilar tumors and propose a hilar-specific anatomical nephrometry scoring system. A total of 414 patients with renal hilar tumors who underwent robot-assisted partial nephrectomy (RAPN) were included in this study, comprising 304 patients from the First Affiliated Hospital of Nanchang University and 110 patients from the Second Affiliated Hospital of Nanchang University, which served as the external validation cohort. To identify predictors of trifecta achievement, we used least absolute shrinkage and selection operator regression and the Boruta algorithm, followed by multivariate logistic regression to identify independent factors. Five ML models were developed and evaluated using receiver operating characteristic curves, calibration plots, decision curve analysis, and precision-recall curves. The generalizability of the model was further validated in external cohort. Finally, we used SHapley Additive exPlanations (SHAP) to interpret the contribution of each predictor and enhance the model's explainability. Furthermore, based on anatomical features identified through logistic regression, we developed a modified nephrometry scoring system and compared its risk stratification performance with the traditional R.E.N.A.L. (i.e., Radius, Exophytic or endophytic, Nearness, Anterior or posterior, and Location) scoring system. Among the 304 patients in the primary cohort, 168 achieved trifecta outcomes. Eight variables were incorporated into the predictive model, with logistic regression model ultimately being selected as the optimal predictive model. It showed robust predictive performance in internal and external validation. SHAP methods identified surgeon, classification of hilar tumor, and radius as the three most significant predictive variables. Compared with the traditional R.E.N.A.L. score, the modified R.E.N.A.L. score demonstrated superior stratification ability for operation time, change in serum creatinine, change in estimated glomerular filtration rate, and trifecta achievement. The interpretable ML model accurately predicts trifecta in RAPN for hilar tumors. The modified R.E.N.A.L. score provides refined anatomical stratification and facilitates individualized surgical planning.