Endourologic stone surgery is where engineering and anatomy meet. At Minerva Health Solutions Inc, we view ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) as carefully orchestrated instrument pathways—not just procedures—that drive outcomes, efficiency, and scope longevity. As part of that toolkit, Minerva offers the AthenaGrasp biopsy forceps for ureteroscopy along with a range of stone baskets designed to support different access strategies and stone locations.
Enginurology 101: why instruments decide your stone outcomes
Endourology treats stones from inside the urinary tract using endoscopic instruments rather than open incisions. The core workflow is consistent:
- Gain access to the ureter and kidney
- Visualize the stone
- Fragment it with energy
- Control pressure and irrigation
- Remove or mobilize fragments
- Ensure safe drainage
Every step is constrained by engineering realities: scope diameter, tip design, deflection, working‑channel size, wire coatings, sheath French size, basket geometry, and even handle ergonomics. Small design choices change what you can safely reach, how efficiently you fragment, and how you manage intrarenal pressure and infection risk. Reviews of ureteroscopy and PCNL consistently highlight that instrumentation and accessory selection impact stone‑free rates, complication profiles, and scope durability.
Residents are usually taught “how to do URS” or “how to do PCNL.” They’re less often taught “why this wire, this sheath, this basket, for this stone and this patient.” Our goal with this article is to give you a clear mental map of the stone toolkit you can adapt to your own practice.
Where URS and PCNL fit in stone management
For most patients who need a procedural intervention beyond conservative management, two techniques dominate: ureteroscopy and percutaneous nephrolithotomy.
Ureteroscopy (URS)
URS is the workhorse for ureteral stones and many intrarenal stones:
- Access is via the urethra and bladder, then up the ureter—no incision.
- Semi‑rigid ureteroscopes handle distal and mid‑ureter; flexible ureteroscopes extend into the proximal ureter and intrarenal collecting system.
- Through the working channel, you deliver guidewires, access sheaths, laser fibers, and retrieval baskets.
From an instrumentation standpoint, URS is about miniaturization and maneuverability: small outer diameters, high‑deflection tips, optimized irrigation, and accessories that fit without killing deflection.
Percutaneous nephrolithotomy (PCNL)
PCNL is the primary choice for larger and more complex renal stone burdens (classically ≥2 cm or staghorn patterns).
- Access is via a small flank puncture into a calyx, then tract dilation to allow nephroscope passage.
- Standard, mini‑, and ultra‑mini PCNL systems use different tract sizes but the same basic concept: endoscopic visualization plus high‑throughput fragmentation and evacuation.
Here, instrumentation centers on robust access, high‑flow irrigation, and powerful lithotripsy/evacuation systems that can manage large stone volumes with acceptable morbidity.
Think of URS as precision work through narrow corridors, and PCNL as controlled renovation through a dedicated access channel. Both depend heavily on the right tools in the right sequence.
The six core instrument families in stone endourology
To make stone instrumentation less overwhelming, it helps to group it into six practical families.
1. Visualization and access
This is how you see and reach the stone:
- Flexible ureteroscopes and semi‑rigid ureteroscopes
- Nephroscopes (standard, mini‑PCNL, ultra‑mini variants)
- Imaging stack (light source, camera, monitor, recording)
Key questions:
- Do we have scope sizes and configurations that match our stone case mix?
- Are we protecting deflection and optics with the accessories we choose?
2. Navigation and support
These instruments create and maintain your “railroad tracks” into the urinary tract:
- Guidewires (hydrophilic, hybrid, and stiff variants)
- Ureteral access sheaths for URS
- PCNL access sheaths and tract dilators (serial and balloon)
Good navigation strategy reduces aborted cases, scope damage, and ureteral trauma. Poor strategy turns a straightforward stone into a stressful, high‑risk case.
3. Lithotripsy and energy delivery
These are your stone‑breaking engines:
- Laser systems and fibers (holmium and newer platforms)
- Pneumatic lithotripters
- Ultrasonic and combined ultrasonic–pneumatic devices
Energy selection influences:
- Fragment size (dust vs larger pieces)
- Operative time
- Need for basketing
- Intrarenal pressure and visualization
Your lithotripsy philosophy should align with your retrieval strategy and your available retrieval tools.
4. Fragment retrieval and containment
Once the stone is broken, you still have to manage the fragments:
- Stone retrieval baskets (tipless vs tipped, nitinol vs steel, three‑wire vs four‑wire vs helical geometries)
- Graspers and forceps (alligator, three‑prong, PCNL‑specific graspers)
- Anti‑retropulsion systems (cones, occlusion balloons, gels/films)
Over‑aggressive basketing, especially in the proximal ureter with large fragments, is still a classic recipe for complications. Smart retrieval strategies balance efficiency, safety, and scope preservation.
5. Irrigation, suction, and pressure control
Intrarenal pressure and visualization are not just comfort issues—they’re safety issues.
- Gravity and pump‑driven irrigation systems
- Suction ureteral access sheaths for URS
- Suction‑enabled mini‑PCNL systems and specialized nephroscopes
Instrument choices here influence infection risk, visualization quality, and how effectively you can clear fragments in high‑burden cases.
6. Drainage and post‑procedure support
Finally, you have to leave the system in a safe, low‑pressure, draining state:
- Ureteral stents (double‑J, single‑J)
- Nephrostomy tubes vs tubeless/totally tubeless PCNL approaches
- Foley catheters and bladder drainage accessories
These are often treated as afterthoughts, but they dictate patient comfort, readmission risk, and the logistics of follow‑up.
Turning principles into a practical instrument pathway
For Minerva Health Solutions, this engineering‑first framework is how we think about building trays, recommending products, and helping OR teams standardize. Literature on URS and PCNL emphasizes that tailoring instrumentation to case mix and anatomy is central to safety and efficiency.
When you design a “stone pathway” for your program, you’re really answering a series of instrument questions:
- How will we access and visualize (URS vs PCNL, scope sizes, imaging stack)?
- What is our default access strategy (wires, sheaths, dilators)?
- What is our energy strategy (laser‑heavy, pneumatic or ultrasonic in PCNL, or hybrids)?
- How do we prefer to retrieve fragments (dusting vs basketing philosophy)?
- How will we manage pressure and irrigation in higher‑risk or infected cases?
- What is our standard drainage policy by stone size and approach?
Once those decisions are explicit, you can align procurement, standardize trays, train staff, and measure outcomes against a clear instrumentation baseline.
From principles to practice with Minerva Health Solutions Inc
If you’re looking to:
Standardize URS or PCNL trays across multiple surgeons
Build a new stone program or upgrade from legacy instrumentation
Map your current inventory to a clearer, outcome‑oriented stone pathway
Minerva Health Solutions Inc can help you translate this framework into concrete instrument sets and sourcing options tailored to your facility.
Suggested calls to action for your site:
- “Schedule a stone tray review with Minerva” – we’ll map your current URS/PCNL sets against this six‑family framework.
- “Download our URS stone instrumentation checklist” – a one‑page snapshot of the core instruments for modern URS stone management.
- “Talk to us about mini‑PCNL and suction‑enabled solutions” – explore options for upgrading access, lithotripsy, and evacuation without over‑complicating your workflow.