As TFL has shown to produce smaller dust particles (or micro-dust) than holmium:YAG the path towards RIRS without requiring basketing has expanded. Nonetheless, as stone analysis is still of paramount importance for proper diagnosis and preventive measures, the authors of this study evaluated the possibility of performing stone analysis only with dust.

A dusting technique was employed in 20 RIRS obtaining fragments and dust (by aspiration through the working channel). Also, to ensure a proper morpho-constitutional analysis (usually done by looking at the stone in a microscope) the authors sent digital videos of the stone surface and stone core to the lab with the corresponding dust.

Biochemical analysis and infrared spectroscopy were performed. Cystine and uric acid stones had accurate analysis. Mixed stones had few (10%) differed analysis and in 5 cases one component was missing. The image added missing information and was of significant help for proper diagnosis. The promising results from this pilot study showed that dust may be enough for stone analysis making RIRS with aspiration a closer dream.

Dusting is becoming the primary technique for lithotripsy. As finer and faster dusting can be achieved new possibilities have opened in terms of improving visualization and ultimately stone free rates.

In this study the authors described a new simple attachment to the scope that can aspirate dust simultaneously during lithotripsy, or in between lasering. The device consisted of 3-way stoppers interconnected, one inlet was used to connect suction and the other for irrigation. The device was called direct in-scope suction (DISS).

The technique was used in 30 patients undergoing lithotripsy with a TFL. The group was compared to 28 patients undergoing RIRS with a suction access sheath and the use of Holmium YAG. Between both groups, the DISS group had double stone size (22 vs 13 mm) and operating time. Nevertheless, the DISS group had shorter hospital stay. Postoperative complications were minor and comparable among groups. Unfortunately, both groups had 35% of residuals and 10 patients with the new device needed a second look. This study shows the feasibility of new techniques for aspiration. For sure is a next step for the future of RIRS where we hope aspiration will increase stone free rates and will allow us to use the full power of lasers, perhaps treating larger stones).

Artificial intelligence (AI) is slowly embracing endourology. Radiomics refers to the application of AI to medical imaging. As any form of AI and automatization process, first a vast amount of imaging and data must be collected aimed to be stored, analysed and managed. These large amounts of complex data are usually called “Big Data”. In radiomics AI is expected to evaluate medical imaging in mathematical models to identified spatial distributions, pixel relations and textures, imperceptible to the human eye with the purpose of making accurate diagnosis, suggest treatments or weigh prognosis. This systematic review revealed that radiomics is already a part of endourology.

Although this is a new evolving technology with initial flaws, it has been used to differ phleboliths from urolithiasis and predict stone composition with high sensitivity. Initial experiences have shown good results to predict stone passage with medical therapy. Finally, there is an initial application to predict stone burden and surgical outcomes that may help to advice for specific treatments. A promising tool that has arrived and will give a lot to talk about in a near future.