MINIATURIZATION OF ENDOUROLOGICAL TECHNIQUES IN THE MANAGEMENT OF UROLITHIASIS: ADVANCES, SAFETY, AND CONSOLIDATION OF A NEW PARADIGM IN MODERN UROLOGY

Abstract

Urolithiasis is a prevalent and recurrent condition with an increasing burden on quality of life and healthcare systems. This critical literature review analyzed 28 studies published between 2015 and 2025 addressing mini-PCNL, micro-PCNL, and digital flexible ureteroscopy. Mini-PCNL achieved stone-free rates above 90% in large calculi, with shorter hospitalization (2–3 days) and reduced transfusion rates (<2%) compared to standard PCNL. Micro-PCNL showed an outstanding safety profile, with negligible blood loss and virtually no need for transfusion, being indicated for stones ≤15 mm, especially in pediatric and high-risk patients, although limited by higher retreatment rates (≈22%) in complex cases. Digital flexible ureteroscopy emerged as the first-line approach for stones ≤20 mm, with low complication rates (<2%) and supported by technological innovations, although still limited by costs. Miniaturization is therefore not only a technological innovation but a new paradigm in modern urology, with the potential to redefine global management protocols for urolithiasis.