The 7th Experts in Stone Disease (ESD) Conference (Bucharest, 2025) produced a practical, multidisciplinary consensus on urinary stone management that synthesizes recent pathophysiologic insights, pharmacologic advances and rapid technological changes in endourology. The ESD 2025 statements complement contemporary society guidance (notably the European Association of Urology 2025 update) by focusing on: (1) why stones cause kidney damage, (2) a stronger emphasis on individualized metabolic and morpho‑compositional diagnostics, (3) prevention with both established and emerging agents, and (4) safe, evidence‑informed use of novel endoscopic tools (suction sheaths, DISS, new lasers and ultra‑thin disposable flexible ureteroscopes).
Why now? Two converging trends made this consensus timely: modern research reframing lithogenesis as a multi‑hit process involving inflammation and renal epithelial responses, and rapid commercialization of new endourologic devices (high‑power lasers, thulium fiber lasers, navigable suction access sheaths, disposable ultra‑slim fURS). ESD 2025 aims to help clinicians translate these advances into safer, more cost‑effective care.
