Ates T. et al., 2025: Global research trends in minimally invasive treatments for kidney stones: A bibliometric analysis (2015-2024).

Tunahan Ates, Ibrahim Halil Sukur, Fesih Ok, Mehmet Gurkan Arikan, Nebil Akdogan
Urolithiasis. 2025 Jun 16;53(1):116. doi: 10.1007/s00240-025-01785-2

Abstract

The prevalence of kidney stone disease has been increasing globally, resulting in a rise in minimally invasive treatment methods. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and endoscopic combined intrarenal surgery (ECIRS) have become standard procedures. This study aims to evaluate global publication trends in this field over the last decade. A bibliometric analysis was conducted using the Web of Science Core Collection database. A total of 3,693 articles published between 2015 and 2024 were analyzed. VOSviewer and Bibliometrix R package were used for data visualization, which included co-authorship networks, keyword co-occurrence analysis, and thematic evolution mapping. However, this analysis did not differentiate between various author roles, which may have influenced the perceived scientific impact of certain researchers, potentially favoring those with strong political or organizational affiliations. China, Turkey, and the USA were the top contributors to publications, with the USA ranking first in total citations. The number of studies has significantly increased over the past decade, indicating a growing trend. The most studied procedures were PCNL and related techniques, followed by RIRS, which has become more popular due to advancements in laser technology and flexible ureteroscopy. Thematic analysis identified trends in postoperative outcomes, complication management, and predictive models for treatment success. Thematic evolution mapping showed a decline in SWL studies, but an increase in interest in ECIRS and multimodal approaches. Minimally invasive kidney stone treatments have advanced significantly, with PCNL remaining the gold standard for large stones and RIRS emerging as a competitive alternative. Future research should focus on optimizing surgical outcomes, integrating AI-based decision support systems, and expanding international collaborations to enhance patient care.

Comment Hans-Göran Tiselius

This report is an extensive bibliometric analysis on minimally invasive treatment of kidney stones during a 10-year period. For details the reader is recommended to scrutinize the text and figures that are based on data collected from 3693 articles. Below I have presented some reflections rather than explanations of the global trend.
Most interesting is the remarkable increase in publications from 2020 until 2024. Obviously, there was a movement of stone research efforts eastwards mainly to China and Turkey, with USA only in position three! Nevertheless, most citations were made on American publications!! China, India and Turkey had the most pronounced literature production.
There was focus on RIRS and ECIRS (combined endourological intrarenal surgery), two fields of interest that had replaced SWL that was in focus previous years. It was of note that the journal in which these results were published was dominated by J Endourology, followed by World J Urology, and Urolithiasis. The most cited publication was, however, the EAU guideline document in European Urology. Otherwise, European Urology was not among the most common sources for the stone concept.
It was not analyzed in this report, but it is commonly well recognized that many reports dealing with minimally invasive stone removal are comprised of information collected from databases and accordingly reflect a lower grade of active stone research.
The increased number of publications during the last five years apparently is a consequence of urologists’ unlimited enthusiasm for endoscopic surgery and subsequently for the eagerness to publish their own results even without any special methodological improvements or surgical tricks. Because in addition to certain technical improvements of endoscopic instruments not very much has happened from a scientific point of view.
This report is focused on minimally invasive stone surgery, but it would have been highly interesting to expand the analysis with the aim of finding to which extent the referred and other centers have published any data on basic urolithiasis research. How do stones form and how can their formation be medically prevented, given the common occurrence of residual fragments after most kinds of modern stone surgery?

Hans-Göran Tiselius