Utility of augmented reality in endoscopic surgery for stones: European Association of Urology endourology up-to-date review.

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Abstract

The development of digital solutions has a direct impact on the modern understanding of the future of urology. Augmented reality is no exception. Specialists use it for intraoperative navigation, which positively impacts procedure metrics, especially in endoscopic surgery for stones. This review aims to determine the chronology of this technology's development and its current trends in endourologists' routine practice. In 2023-2025, studies confirmed the clinical benefits of augmented reality navigation, including reduced puncture time and decreased complication rates. At the same time, the development of intelligent systems with ultrasound/computed tomography (CT) fusion and deep learning has taken augmented reality from visualization to active optimization of the accuracy and safety of interventions. In retrograde surgery, spatial navigation and instrument tracking, complemented by cognitive-oriented and gaze-based systems, have become key areas of focus, paving the way for objective assessment of surgeons' visual strategies and personalized training. Augmented reality (AR) and mixed reality (MR) are rapidly transforming endoscopic surgery for urolithiasis: in percutaneous nephrolithotripsy (PCNL), these technologies have already reached clinical maturity as navigation tools, while in ureteroscopy (URS) and retrograde intrarenal surgery (RIRS), they are emerging as powerful cognitive and navigation platforms. Despite differences in current application scenarios, both trajectories converge toward a common goal: to make key stages of stone treatment measurable, reproducible, and less dependent on the individual experience of the surgeon. The integration of augmented reality with real-time visualization, artificial intelligence, and attention tracking systems is likely to redefine the standards of accuracy and quality in endourology in the coming years.

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