Nephrolithiasis in the Era of Precision Medicine: Progression in Diagnostic,Therapeutic and Preventive Strategies

Abstract

Nephrolithiasis is one of the most prevalent urologic conditions globally and is recognized as a considerable clinical public health challenge with its rising incidence and recurrence. The techniques of metabolic evaluation, novel diagnostic imaging and systemic mechanisms that result in greater stone deposition, together with advances in biochemical/molecular characterization relevant to lithogenicity, as well as end-urological instrumentation, have altered the modern approach for detection, tonsorial management and prophylaxis against STONES. We review
current imaging modalities, including low-dose dual-energy computed tomography, point-of-care ultrasonography and stone composition analysis techniques/new urinary biomarkers. Pending modern day therapeutic breakthroughs, including thulium fiber laser lithotripsy and new advances in high-fidelity rigid percutaneous nephrolithotomy
techniques, ultrathin flexible digital ureteroscopy and robotic surgical interventions as well as improvements in ureteral stenting and access sheaths, are also summarized herein. This updates the contemporary evidence-based preventive strategies with the biggest opportunities around urinary microbiome, genetic predisposition and artificial
intelligence-driven predictive modeling to enable precision-based, personalized renal stone disease approaches.