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Urolithiasis is a major health problem which is on the rise worldwide. New procedures and technological tools have arisen, providing the urologist with a vast arsenal of options for stone disease management. The goal of this narrative review is to summarize the most recent advancements and demonstrate their efficacy in reducing complications and increasing surgical efficacy. The latest modern advances in increasing stone rate after flexible ureteroscopy were included. The ureteral access sheet concept represents one of the most important parts in this procedure and new performances achieved in this field like suction and pressure control were evaluated. Another important aspect in flexible ureteroscopy is related to laser fibres. The latest achievements in Holmium and Thulium fibres were analysed and compared using both dusting and fragmenting techniques. After analysing these aspects, the conclusion was that suction improved visualization by removing "stone storm" and bleeding during the procedure and Thulium laser had the potential to become the new “gold standard” in the pursuit of obtaining a higher stone free rate.

Introduction: Horseshoe kidney (HSK) is one of the most frequent renal malformations which appears to present an increased risk of stone formation caused by abnormal urine drainage. This study aims to compare the results of single-use flexible ureteroscopy (SUfURS) vs reusable devices (RfURS) with holmium laser in treating stones in HSK cases. Material and method: Between February 2017 and June 2021, 29 patients diagnosed with renal stone disease and horseshoe kidney were retrospectively analyzed. Subjects were divided into two groups: Group 1 (14 patients) undergoing SUfURS and Group 2 (15 patients) operated with RfURS devices. We analyzed the mean stone burden, operation time, stone free rate and complications. The surgical equipment was represented by the SUfURS PU3022 (Zhuhai Pusen Medical Technology) and RfURS URF-V2 (Olympus). Results: The two groups had a similar mean stone burden: 22 ± 6 mm (range 15-31 mm) for Group 1 and 24 ± 7 mm (range 16-30 mm) for Group 2. The average operative time was better for Group 1 (86 ± 17 min) vs Group 2 (89 ± 20 min). The stone-free status was similar for both groups after the first session (57.14% for Group 1 vs 53.33% for Group 2) and slightly in favor of Group 1 as compared to Group 2 (85.71% vs 73.33%, respectively) after the second session. The overall complication rate (Grades I, II and III) was almost similar in both groups, with a slightly prevalence for Group 1 (no major complications Grade IV and V). Conclusion:Flexible ureteroscopy represents an effective alternative treatment technique for large stones in kidney abnormalities. single-use flexible ureteroscopy can be successfully used to treat patients with genetically renal malformations and its results may be slightly better than those provided by using RfURS devices.