Technology & Innovation in Urology

The Holmium laser operates at a wavelength of 2,100 nm — absorbed strongly by water in the stone itself. When the laser fibre tip is positioned against a stone and fired in short pulses, energy is transferred directly into the stone, causing it to fragment or, with the right settings, vaporise into fine dust (a technique known as dusting or vapourisation).

Dusting mode produces fragments so small — under 1 mm — that they pass out in the urine on their own, eliminating the need for basket retrieval and significantly shortening procedure time.

• Step 1 — Access

  A flexible ureteroscope is passed through the urethra, bladder, and ureter into the kidney. No incision is made at any point.
• Step 2 — Visualisation

  The stone is directly visualised on a high-definition monitor. The urologist navigates the flexible scope to reach stones even in the most difficult lower-pole calyces.
• Step 3 — Laser delivery

  A laser fibre (200–365 µm diameter) is passed through the scope's working channel and positioned against the stone. Laser energy is applied until the stone is fragmented or dusted.
• Step 4 — Retrieval or passage

  Large fragments are retrieved with a stone basket; dust particles pass spontaneously. A ureteric stent is placed to ensure drainage and then removed 10–14 days later.
• Step 5 — Confirmation

  CT KUB at 4 weeks confirms stone-free status and assesses kidney function.

The Thulium Fibre Laser, increasingly available at leading centres, offers even finer dusting capability and continuous wave delivery — meaning shorter procedure times and more thorough stone clearance than first-generation Holmium systems.

For the vast majority of urological procedures today — kidney stone surgery, prostate surgery, bladder tumour resection, and even radical nephrectomy for kidney cancer — minimally invasive approaches deliver outcomes equivalent or superior to open surgery, with substantially better patient experience and recovery.

Modern single-use flexible ureteroscopes are marvels of engineering compressed into a shaft thinner than a standard pencil. The instrument combines a high-definition camera at the tip, a dedicated irrigation channel for continuous saline flow, a working channel through which laser fibres and stone baskets are passed, and an active deflection mechanism controlled by the surgeon's thumb.

Single-use (disposable) ureteroscopes, now widely used at leading centres, eliminate the cross-infection risk associated with reprocessed instruments and ensure every patient receives a scope with optimal optics and deflection — a meaningful quality improvement over reusable instruments that degrade with repeated sterilisation.

• Tip — Camera

  Chip-on-tip CMOS sensor delivers HD or 4K video directly from inside the kidney. Images are displayed on a large-format surgical monitor, with the surgeon steering the scope in real time.
• Shaft — Irrigation channel

  Continuous low-pressure saline irrigation maintains a clear visual field, washes out stone debris, and prevents thermal build-up during laser firing.
• Shaft — Working channel

  A 3.6 Fr working channel accommodates laser fibres (200–365 µm), nitinol stone baskets for fragment retrieval, and biopsy forceps for tissue sampling when needed.
• Handle — Deflection control

  A thumb-operated lever provides active tip deflection of up to 270°, enabling navigation to lower-pole calyces — the area most frequently harbouring stones and least accessible by other techniques.

Traditional TRUS (transrectal ultrasound-guided) prostate biopsy takes 12 random samples from the prostate, frequently missing clinically significant cancers while simultaneously over-diagnosing low-grade tumours that do not require treatment. Multiparametric MRI (mpMRI) combined with real-time fusion biopsy has fundamentally changed this.

In the MRI-fusion workflow, a multiparametric MRI of the prostate is performed first. Radiologists identify and grade suspicious lesions using the PI-RADS scoring system (scores 1–5). Only lesions scoring PI-RADS 3 or higher are then targeted at biopsy — with the MRI image fused in real time to the live ultrasound feed, guiding the biopsy needle to the exact lesion identified on MRI.

Fusion biopsy detects approximately 30% more clinically significant prostate cancers than standard random biopsy, while simultaneously reducing detection of insignificant low-grade tumours — meaning fewer unnecessary treatments and fewer missed high-grade cancers.

Prostate-specific membrane antigen (PSMA) PET-CT is a nuclear medicine imaging technique that uses a radiolabelled tracer targeting PSMA — a protein overexpressed on prostate cancer cells — to detect even very small deposits of cancer throughout the body. It is now considered superior to conventional CT and bone scan for staging high-risk prostate cancer and detecting biochemical recurrence after treatment.

PSMA PET-CT can detect recurrent prostate cancer deposits as small as 3–4 mm — sites that conventional CT and bone scan would entirely miss. For patients with rising PSA after prostatectomy or radiotherapy, this changes management in 50–60% of cases.