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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 the winter issue of Stone News.
As new laser technologies have emerged achieving micro-dust, new techniques to evaluate stone composition from dust have been described. This will be very important in a near future as aspiration methods will be included in our armamentarium. In this same line, the second article evaluates in-scope suction discussing one of the most needed tools in endourology.
Finally, we will look to radiomics in urolithiasis, a new term we need to be familiar with as AI will be a main character of our system.
We have three great papers to discuss from latest literature regarding stone disease, please enjoy.
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![img](img/investigar.png) |
A. Duration of Follow-up and Timing of Discharge from Imaging Follow-up, in Adult Patients with Urolithiasis After Surgical or Medical Intervention: A Systematic Review and Meta-analysis from the European Association of Urology Guideline Panel on Urolithiasis.
Tzelves L et al. Eur Urol Focus. 2023
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3' |
https://pubmed.ncbi.nlm.nih.gov/35851252/
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One of the most common questions from patients and endourologists is how long we must follow-up our patients. The main problem is that stone disease is a very complex illness that takes into consideration many variables as patients characteristics and stone characteristics. Having 7 stone types and 23 subtypes, we cannot expect to follow or patients equally.
For this, the EAU urolithiasis guidelines performed a systematic review and meta-analysis in order to have the best evidence available to recommend an easy, yet accurate, follow-up flow chart. The main evaluation was done after treatment and three main groups were identified. Fist, the best scenario: stone free, low risk patients, that needed to be followed for 5 years with KUB or KUB US to have a 90% “safety margin”. Patients with residuals stones of less than 4 mm were recommended to be followed for 4 years or to perform a reintervention.
For this patients, medical treatment could be an option before retreatment. Patients with residuals of more than 4 mm, a reintervention was recommended as stone events are likely to happen. Finally, high risk patients had their own recommendations and follow up for 4 years and consider discharge if no progression continuing treatment. Those that are not in medical treatment should be followed for 10 years. We could add that in general during follow up proper alkalinization or urine acidification should be advice depending on the stone type.
This flow chart gives us a pretty good idea of how to follow-up our patients according to their risk of stone events while decreasing the burden of the health system.
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