# Kimura Y. et al., 2026: The Changing Landscape of Urological Surgery: 10-Year Trends in Benign Prostatic Hyperplasia and Upper Urinary Tract Stone Management in the San-in Region, Japan. Hans-Göran Tiselius Friday, 25 September 2026 248 Hits [ 0 Comments ](https://www.storzmedical.com/en/disciplines/literature-database-blog/database-lithotripsy/kimura-y-et-al-2026/?layout=listings#comments) Kimura Y, Morizane S, Yamamoto A, Omatsu R, Yamane H, Teraoka S, Nishikawa R, Yamaguchi N, Hikita K, Takenaka A. Yonago Acta Med. 2026 Apr 29;69(2):178-187. [doi: 10.33160/yam.2026.05.005](https://pubmed.ncbi.nlm.nih.gov/42186464/) ## Abstract Background: The surgical management of benign prostatic hyperplasia (BPH) and upper urinary tract stones has remarkably evolved with technological advances. In this study, the trends in surgical techniques for these conditions in the San-in region of Japan were analyzed over a 10-year period. Methods: A retrospective survey was conducted across 17 urological facilities in the San-in region (Tottori and Shimane prefectures) from 2014 to 2023. Data on the surgical procedures for BPH and upper urinary tract stones were collected, including the facility adoption rates and annual case volumes. Results: For BPH treatment, HoLEP and bipolar TUR-P were the commonly performed procedures, with HoLEP accounting for approximately 50% of all cases. Minimally invasive surgical treatments, including water vapor energy (WAVE) and prostatic urethral lift (PUL), were introduced in 2022. For upper urinary tract stones, the utilization of TUL/URS equipped with holmium laser dramatically increased from 33.9% to 64.9% of all cases, whereas that of extracorporeal shock wave lithotripsy (ESWL) decreased from 59.9% to 32.1%. Conclusion: This study shows the successful adoption of advanced urological techniques in rural Japan, with clear trends toward laser-based procedures for BPH and stone treatment. The observed decline in ESWL utilization is consistent with national and international trends, reflecting a global paradigm shift toward the endoscopic management of upper urinary tract stones. ## Comment Hans-Göran Tiselius There is no doubt that we have witnessed an amazing technical development and shift in the management of patients with urological diseases. This specific report shows how the treatment of prostatic hyperplasia and urolithiasis have changed during the past years. For both conditions it is evident that application of different kinds of laser technology dramatically have altered the treatment principles. In the Japanese region from which the authors come, the change in stone management is particularly obvious for transurethral ureterolithotomy, percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. For stone treatment, the most remarkable trends are increased transurethral ureterolithotomy and decreased SWL. Most certainly this change is caused by the fact that endoscopic surgery is more attractive to most young urologists. This trend has been observed worldwide during the last decade or so. But this course also is an effect of insufficient technical development of SWL. Urologists have not fully appreciated the non-invasive and non-anaesthesia requiring method that effective SWL provides. The problem is that the indications for SWL have narrowed instead of being expanded and there are certainly many explanations for this unfortunate trend. In view of the early experience with the Dornier HM3 it is obvious that there definitely is room for technical improvements also of SWL. An improved least invasive method for stone removal definitely will be beneficial in terms of versatility, complications, comfort and economics. It thus is important to convince urologists that there might be a possible alternative to their enthusiasm for endoscopy, provided improved SWL-results can be demonstrated by technical modifications of our currently available lithotripters. *Hans-Göran Tiselius* 0 #### Comments No comments made yet. Be the first to submit a comment Sunday, 08 November 2026 I have read and agreed to the [Privacy Policy](https://www.storzmedical.com/javascript:void(0);)