Editorial: Prevention and treatment of urolithiasis: innovation and novel techniques

The imperative for this work is underscored by contemporary epidemiological data. The study "Trends in the burden of urolithiasis in China: an analysis from the global burden of disease study 2021" adds onto the existing data a crucial macro-perspective, revealing not only the sheer scale of the disease but also evolving demographic patterns that must inform resource allocation and preventative strategies [5].True progress in urolithiasis begins with a shift from reactive treatment to proactive, individualized prevention. The cornerstone of this paradigm is a deeper understanding of etiology. The article "Genetics of kidney stones and the role of genetic testing in prevention: a guide for urologists" elegantly bridges the gap between molecular science and clinical practice, integrating genetic counseling and testing into the standard metabolic workup for high-risk or early-onset stone formers can unveil monogenic causes allowing for targeted therapy and family screening. This represents the vanguard of personalized medicine in nephrolithiasis [6,7]. Simultaneously, modifiable risk factors remain paramount. The "Agestratified analysis of the BMI-kidney stone relationship: findings from a national crosssectional study" offers nuanced insights, demonstrating that the obesity-stone risk association is not uniform across the lifespan, thereby refining targeted preventative counseling.On the therapeutic front, the latest recurrent themes are suction and miniaturized equipments, maximizing efficacy while minimizing morbidity. Suction is arguably the final piece of the puzzle in endourological stone management, facilitating superior stone clearance, improved stone-free rates, and enhanced procedural safety by maintaining lower intrarenal pressures and reducing infectious risks [8][9][10].The evolution of percutaneous nephrolithotomy (PCNL), the gold standard for large renal stones, is particularly well-documented [11]. We see a move towards optimizing outcomes through better preoperative planning, as exemplified by the "B.T.C.H. nephrolithometry score: a novel scoring system to predict stone-free rate and complexity for ultrasoundguided percutaneous nephrolithotomy." This tool aims to provide surgeons with a reliable, imaging-based metric to tailor their approach. Concurrently, the trend towards minimizing tract size and improving patient comfort is clear [12]. As previously demonstrated by the randomized controlled trial by Zeng et al [13], "Innovations in kidney stone management: mini-PCNL for staghorn calculi in resource-limited settings" again proved that complex stone burdens can be effectively managed with mini PCNL, reducing bleeding risks and enhancing recovery. The integration of suction in PCNL is a key part of this evolution, contributing to improved outcomes. "Prospective study of the efficacy of PCNL under local anesthesia based on the ERAS concept," challenges traditional anesthesia dogma, demonstrating PCNL under local anesthesia is a feasible, safe, and effective option with significant benefits in postoperative recovery and cost-effectiveness.Technical ingenuity is further highlighted in approaches to complex anatomy and stone configurations by works "Needle nephroscope combined with ureteroscope via a single standard percutaneous nephrolithotomy channel for the treatment of complex nonobstructing renal stones" and "Percutaneous nephrolithotomy for renal stones combined with laser endoscopy for ipsilateral renal cysts: a case report and literature review." "Retrograde intrarenal surgery in the prone split-leg position for female upper urinary tract stones: a preliminary study of 16 cases" explores an alternative patient positioning that may offer ergonomic advantages in selected cases.Flexible ureteroscopy continues to see pivotal advancements with the introduction of flexible and navigable suction ureteral access sheaths (FANS) [8,9,14], miniaturized ureteroscopes with integrated functions [15]. While "Paired analysis of flexible and navigable suction ureteral access sheath vs. conventional ureteral access sheath, both combined with needle-perc assisted endoscopic surgery, for the treatment of