Table 2.

Overview of New Technologies (*Not Exhaustive List)

Technology	Example/Manufacturer*	Description	Advantages	Disadvantages
Thulium Fiber laser (TFL)	SOLTIVE (Olympus) Fiberlase (NTO IRE-Polus)	Novel laser technology with properties which should allow more efficient lithotripsy and reduced photothermal damage to other structures. Uses laser diode rather than flash lamp.	-Less retropulsion -Higher frequency range (up to 2400Hz) -Faster stone ablation rate	-Lack of randomised trials -No cost data
Moses Homium laser	Moses technology (Lumenis) Vapor Tunnel (Quanta system)	Novel modulation of laser pulse allows improved stone fragmentation as a result of better transmission of energy in water	-Increases ablation rate -Reduces retropulsion	-Limited clinical studies on technology -Higher cost
Anti retropulsive devices (ARDs)	Stone Cone/Escape/Lithocatch/ Parachute (Boston Scientific) NTrap (Cook Medical) Accordion (Endotherapeutics) XenX (Xenolith Medical)	Prevent retrograde migration of stone fragments during lithotripsy	-Reduced retropulsion rate -Potential to reduce retreatment rate	-Added cost of procedure (may be offset by reduced need additional procedures) -Some devices liable to damage from laser -Some devices not wide enough for use dilated ureter(s)
Ureteral access sheath (UAS)	Flexor (Cook Medical) UroPass (Olympus) Bi-Flex Evo (Rocamed) Navigator (Boston Scientific)	Allow repeat access to kidney with ureteroscope	-Decrease intrarenal pressure -Repeat and rapid entry to renal pelvis -Improved visibility -Reduced operative time	-Placement can be difficult -Intra-operative complications eg, tear, perforation -Post-operative complications eg, stricture -Over dilation for insertion