Scilipoti P. et al., 2026: . The Shifting Geography of Innovation in Endourology.

Scilipoti P, Panthier F, Perri D, Goumas IK, Bozzini G, Somani BK, Traxer O, Ventimiglia E.
Eur Urol. 2026 Jun 19:S0302-2838(26)02214-1. doi: 10.1016/j.eururo.2026.05.033. Epub ahead of print.

Abstract

The geographic origin of endourological innovation is undergoing a fundamental and measurable transformation. This editorial maps a decisive shift across four domains: suction-integrated ureteroscopy and ureteral access sheaths (UASs), single-use flexible ureteroscopes, laser lithotripsy platforms, and robotic flexible ureteroscopy, using four independent indicators: Food and Drug Administration (FDA) regulatory clearances, international patent filings, citation impact, and guideline representation. The turning point for suction-enabled ureteroscopy was 2016, when Well Lead Medical (China) obtained the first FDA 510(k) clearance for a suction-capable UAS, with Chinese manufacturers subsequently dominating new approvals in this category. In single-use ureteroscopy, between 2022 and April 2026, Chinese manufacturers accounted for 47% of FDA 510(k) clearances, matching the USA in absolute count for the first time in the history of the field. In laser lithotripsy, China's share of annual patent filings grew from <10% to >35% between 2015 and 2024. In robotic flexible ureteroscopy, Asian manufacturers are now entering a field previously defined by European and Turkish platforms. Analysis of the EAU Urolithiasis Guidelines 2026 (n = 312 publications, from 2018) reveals that European publications have historically dominated citations (37.8%), followed by Asia (27.9%) and North America (19.2%); strikingly, Asian publications surpassed Europe in annual citation share by 2025, driven by a dramatic rise since 2023. For European and North American stakeholders, the appropriate response is not defensiveness but strategic engagement, through international collaboration, cross-border training, and institutional adaptability, in the shared interest of improving patient care worldwide.

Comment Hans-Göran Tiselius

An interesting report on the development of endourological instruments. Up to 2016/2020 most innovations in this field originated from USA and Europe, but after that China is the absolute leader. The most remarkable developments were:

1. Flexible and navigable ureteral excess sheath (UAS) and suction capable UAS.
2. Single use flexible ureteroscope and laser lithotripsy.
3. Robotic flexible URS

In addition, but not mentioned in this article, is the development for devices aiming at elimination of residual fragments after SWL.

Hans-Göran Tiselius