How to cite: Streeper NM. 2026 AUA Guidelines Surgical Management of Kidney Stones: What’s New. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/2026-aua-guidelines-surgical-management-of-kidney-stones-whats-new/
Summary
Necole M. Streeper, MD, Associate Professor of Urology, Medical College of Wisconsin, Madison, Wisconsin, reviews updates to the 2026 American Urological Association guideline on surgical management of kidney stones. The updated guideline incorporates literature from 2000 through 2025 and includes numerous conditional recommendations based on available evidence.
Dr. Streeper begins by outlining the treatment algorithm, emphasizing that surgical management is determined by both stone size and location. She highlights the addition of mini percutaneous nephrolithotomy (PCNL) as a treatment option, particularly for stones between 1 and 3 centimeters. For stones between 1 and 2 centimeters, mini PCNL may be offered over ureteroscopy due to higher stone-free rates, although ureteroscopy may have advantages in specific locations.
She reviews recommendations for managing patients with recurrent urinary tract infections and non-obstructing stones, noting that clinicians may offer elective stone removal to reduce infection risk, while emphasizing the importance of counseling patients about variable success rates.
Updates in PCNL include the option to continue low-dose aspirin and the potential use of tranexamic acid to reduce bleeding, with consideration of contraindications and variability in study results.
The guideline also recommends that during ureteroscopy or PCNL, clinicians should offer treatment of additional asymptomatic non-obstructing stones measuring 6 millimeters or less to reduce future stone-related events.
For shockwave lithotripsy, clinicians may omit prophylactic antibiotics in patients without infection. Repeat shockwave treatment may be considered after an incomplete response, with transition to ureteroscopy after failed retreatment.
Dr. Streeper discusses newer technologies, including suction sheaths and single-use ureteroscopes, which may improve stone-free rates, as well as considerations in laser selection and energy settings to reduce the risk of ureteral injury. She emphasizes multimodal non-opioid pain management strategies following stone surgery.
About the 45th Annual Ralph E. Hopkins Urology Seminar
The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.
ABOUT THE AUTHOR
Necole M. Streeper, MD, is an Associate Professor of Urology at the Medical College of Wisconsin, Madison, Wisconsin. She specializes in surgically treating complex kidney stone disease and the prevention of kidney stones.
Dr. Streeper earned her medical degree from the University of Iowa. After a residency in Urology at the University of Texas Health Science Center, she completed a fellowship in Endourology and Minimally Invasive Surgery at the University of Wisconsin-Madison.
Dr. Streeper’s clinical research is dedicated to improving the prevention and treatment of kidney stones, and she is interested in identifying management strategies to improve the quality of life in patients with kidney stones. She has received NIH/NIDDK grant support to develop technology (SipIT) to improve fluid consumption for the prevention of kidney stones. Dr. Streeper is the lead investigator for MCW as a research site in the North American Stone Quality of Life Consortium, and has authored more than 50 research publications and book chapters in the field of kidney stone disease.
