This paper published, at no other than the New England Journal of Medicine, evaluated one of the topics most questioned by clinicians regarding calcium stones prevention, do thiazides (HCTZ) really help? This intervention has been recommended in patients with high grade hypercalciuria depside low grade evidence. This multicentric group from Switzerland, randomized 416 patients (doble blinded), giving low, medium and high doses of HCTZ compared to placebo and followed them for 3 years!

First, we must mention that there was no correlation on symptomatic or radiological recurrence. Also, there was no substantial improvement on recurrence in patients taking HCTZ compared to placebo. This high-quality paper will be highly cited in all guidelines probably towards not recommending giving HCTZ anymore.

High risk patients, specially cystinuric patients, must be carefully monitored to prevent stone events. Adequate urinary pH control with medication and proper monitoring needs to be implemented. This randomized controlled trial evaluated two methods of self-pH monitoring in cystinuric patients, strips and a personalized electronic monitor (pH meter).

The patients were given medication for adequate urine alkalinization and surprisingly most of the patients did not achieve a proper pH (ranged from 7 to 8) which leads us to acknowledge that adequate pH monitoring is essential for counseling our patients to achieve this therapeutic-prevention ranges.

The study results showed that patients were satisfied with both methods, but the pH-meter was easier to use, handle and most important, to interpret, which is key for the self-monitoring process.

The current standard for stone evaluation is the morpho-compositional analysis, that includes optic (stereoscopic) microscopy evaluation and infrared spectrometry. This study group have included in their daily protocol evaluations with an electron microscope.

This method provides an augmentation of 20.000x, showing an impeccable crystal morphology, which may be decisive on determining the stone etiology specially when the infrared spectroscopy may fail. Further from seeing the crystal structure and the stone origin an X-ray scattering analysis can also be used to look at minor component of the stone and identify a specific stone composition in a particular area of the stone. Finally, an interesting feature is the identification of the relations of different crystals and their relations to stone growth. This fast and reliable method may be implemented to get the most of our stone for diagnosis.