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Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5

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Objective: The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model. Methods: Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 lm and 200 lm) and Ho:YAG (270 lm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W. Results: Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 lm fiber at 2.4 W resulted in a 2.6 C rise from baseline (p ¼ 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 C (p ¼ 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 lm was 39.6 C compared to 44.9 C using 200 lm, p < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers. Conclusion:In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.

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