#11 Click here to see the previous editions October 29, 2022
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Hello and welcome to the Stone News by Devicare, where we discuss every 2 months the most recent and relevant studies in stone disease.

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Dear Stone fans. Welcome to this autumn issue of Stone news.

In today’s newsletter we will discuss new technologies as burst wave lithotripsy and ultrasonic propulsion that may change future of stone treatment. Then we will see a very common scenario in our specialty that is how to measure properly urinary pH in patients using potassium citrate. Finally, as more and more flexible ureteroscopies are done with digital scopes, we will discuss if urologists can accurately identify the different types of stone composition. We have three great papers to discuss from latest literature regarding stone disease, please enjoy.

img First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones. M K Hall et al. J Urol 2022 img 2'
https://pubmed.ncbi.nlm.nih.gov/36205340/ img

Patients with symptomatic ureteral stones needs quick and effective treatments. This study evaluated an ultrasonic propulsion method to reposition and help expel ureteral stones and the burst wave lithotripsy to break the stones; both emitted from a single “regular” ultrasonic probe. In this clinical trial, 29 patients with proximal and distal ureteral stones were recruited. Sixteen patients underwent ultrasonic propulsion alone and 13 with burst wave lithotripsy in 10 minute sessions.

All patients were treated without anesthesia or sedation with pain scores of less than 2. The outcome of stone motion was seen in 19 of the 29 patients (two patients expelled the stone to the bladder with immediate relief). Finally, the stone passed in 18 of the 21 distal ureteral stones in an average of 4 to 5 days after procedure.

There were only mild complications: Ten patients continued pain medication and only 2 patients had increased pain from before the procedure. Seven patients had limited hematuria and 18 patients had warming on the skin. The authors concluded that this new technology seems to be safe and effective and may be a great bridge between expectant management and urological intervention for symptomatic ureteral stones. 

img Fasting and 24-h urine pH in patients with urolithiasis using potassium citrate. da Silva IBL et al. Am J Clin Exp Urol. 2022 img 2'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301065/ img

Nowadays there are many patients with urolithiasis taking potassium citrate to prevent (or dissolve) uric acid or cistine stones, to increase urinary citrate levels or to treat mild hipercalciuria. In these patients is very important to accurately measure urinary pH to make a proper follow up and adjust the medication. There were some questions regarding the proper methods to measure urinary pH whether is was better a 24h urine collection or a fasting simple; Also the proper measurement methods utilized as many patients use strip test. In this study both methods were evaluated and measured with test strip and a digital meter.

The results showed that a fasting sample represented an efficient method without the need of 24h urine samples (seen before as a gold standard) as mean values were similar. However, there was a significant better testing with digital meters concluding that the strip tests were not reliable. This important message helps us on guiding our patients on how to properly follow up their urinary pH with the most accurate method to ensure the best medication dosage and effectiveness.

img How Reliable Is Endoscopic Stone Recognition? A Comparison Between Visual Stone Identification and Formal Stone Analysis. Journal of Endourology. Henderickx M et al. J Endourology. img 3'
https://pubmed.ncbi.nlm.nih.gov/35651279/ img

Urologists are increasingly performing flexible ureteroscopy for the treatment of kidney stones; Also, digital scopes are on the rise as single use scopes are widely available. As digital imaging provides better view the authors studied the capacity of expert surgeons to identify the composition of kidney stones just based on the stone view from a digital scope compared to the final infrared spectroscopy report. 15 experienced endourologists examined 100 videos of different kind of stones (evaluating both the surface, and in some, the nucleus of the stone).

The videos were evaluated twice in a period of two months to see the intra-observer agreement. The highest result from both evaluations showed that urologist correctly predict CaOxDi stones in 75% of cases but calcium hydrophosphate was correctly diagnosed in only 10%. CaOxMono in 59% and calcium magnesium phosphate was not correctly predicted in any case. Uric acid diagnosis was correct in 22% of cases. Cystine stones had the best score, correctly predicted in 80% of cases.

We may say that the problem is that most of stones are mixed but when sub analyzing only pure stones CaOxMo increased to 65% and uric acid to 29%. This great study suggest that visual diagnosis is not accurate and infrared spectrometry and morpho-constitutional analysis is still the gold standard of care. It is very important to correctly analyze the stones to properly prevent recurrences.

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