Finally! The randomized controlled trial that we all have been waiting since the introduction of the thulium fiber laser (TFL) in here. This trial compares patients undergoing ureteroscopy (for ureteral and renal stones) treated with TFL and a 30W Holmium laser. Standard and safe settings were used for both (0.4 J at 6 Hz in the ureter and 0.8 J at 20 Hz in the renal pelvis). Unfortunately, the pulse modulations were not mentioned. With similar demographics among groups the trial showed that TFL had significant lower operative times (49 vs 57 min), and better stone free rates for renal stones, 80 vs 57%, defined as “Zero fragments” (with CT!).

As the authors conclude this trial supports the use of TFL as the laser of choice for ureteroscopy. Furthers studies still needed to evaluate if this results are consistent with the use of new generation holmium lasers and their pulse modulations.  

Obesity is a chronic disease leading to substantial morbidity. Also, it is known that is a risk factor for developing stones, especially uric acid stones within the obesity-related metabolic syndrome. Dietary and lifestyle recommendations as well as urinary ph medication have been the pillars to prevent stone recurrence in such patients.

    This study evaluated obese patients with calcium oxalate stones undergoing a hypo-caloric diet. The authors showed that patients did had a significant reduction in mean weight, that was correlated to urinary pH modifications but did not see improvements in 24 h urinary analysis. Even if the authors did not show improvements in the 24h-urine sample, weight loss should be recommended to improve the patient’s quality of live and reduce overall morbidity and mortality.

Enhanced recovery after surgery (ERAS) protocols have been widely studied in oncology with promising results. The authors created an ERAS protocol in patients undergoing URS modifying prescribed medications or interventions (as peripheral IV placements) to optimized patients comfort aiming to reduce postoperative unplanned patient-initiated encounters. 96 consecutive patients were eligible for the protocol and were compared to patients previously treated. Demographics and operative data was comparable among groups. ED visits and hospital addition rates were similar between groups, although patients undergoing the ERAS protocol made fewer phone calls or electronic medical record messages. Of those contacts, fewer were pain-related or medication related questions after ERAS.

This data indicates that well informed patients undergoing such multimodal perioperative care approaches may improve the patients experience and probably outcomes.