PREVENTION OF UROLOGIC CALCULI - BEHAVIOURAL, DIETARY, AND MEDICAL ASPECTS: Edited by Evangelos Liatsikos and Margaret PearleAnatomic variations and stone formationJung, Helenea,b; Pless, Maria S.a; Osther, Palle J.S.a,bAuthor Information aUrological Research Center, Lillebaelt Hospital, Beriderbakken, Vejle bInstitute of Regional Health Research, University of Southern Denmark, Denmark Correspondence to Palle J.S. Osther, MD, PhD, Department of Urology, Lillebaelt Hospital, Beriderbakken 4, DK-7100 Vejle, Denmark. E-mail: email@example.com Current Opinion in Urology: September 2018 - Volume 28 - Issue 5 - p 420-427 doi: 10.1097/MOU.0000000000000519 Buy Metrics Abstract Purpose of review The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. Recent findings Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. Summary Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.