Stone fragmentation in percutaneous surgery: is there a paradigm shift?

Overall, current evidence supports a shift in PCNL from mechanical fragmentation and fragment extraction towards laser-driven dusting combined with active aspiration. This evolution appears to prioritize efficiency and physiological safety rather than absolute gains in stone-free rates. However, its broader adoption remains dependent on cost, equipment availability, and training, underscoring the need for further comparative and implementation-focused research.