Kevin Koo, MD, on the impact of intraoperative kidney stone measurement

A recent study found that intraoperative digital stone measurement led to a change in surgeon decision-making in 28% of cases, underscoring the potential impact of real-time kidney stone assessments.¹ 

In a recent interview with Urology Times®, senior author Kevin Koo, MD, MPH, broke down the scenarios where surgeons found intraoperative assessment most impactful and outlined the implications of this tool for clinical care. Koo is a urologist at Mayo Clinic in Rochester, Minnesota.

In total, the study prospectively enrolled 106 patients who were undergoing flexible ureteroscopy and holmium laser lithotripsy for renal stones. During the study, surgeons could request intraoperative measurements of fragments in real time. Surveys were conducted after each case to assess the reasons for taking measurements and the impact of the data on intraoperative decisions.

Data showed that surgeons took an average of 2.4 measurement per case. In the 28% of cases where plans were changed intraoperatively, surgeons instead opted to continue lithotripsy (11%), extract the fragments (14%), or leave the fragments behind for passage (3%).

Koo added, “If we can give surgeons information about how the procedure is going and how lithotripsy is progressing, then that can give surgeons the confidence to complete lithotripsy in an efficient way, and to complete their procedures as quickly and as safely as possible to optimize patient outcomes.”

REFERENCE

1. Krueger ABC, Smith DM, Parzych AT, et al. Impact of intraoperative digital stone measurement on surgeon decision making in ureteroscopy. Urology. 2025:S0090-4295(25)00643-0. doi:10.1016/j.urology.2025.06.064