#17 Click here to see the previous editions October 10, 2023
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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 late summer edition of Stone News.

In today’s newsletter we will discuss three important topics related to stone management. First, we will review an important paper that I invite everyone to read on safety measures of lasers. Then we will discuss the recent literature of the new Thulium YAG pulsed laser for urolithiasis, and finally we will get up-to up to date on medical management for sent related symptoms.

We have three great papers to discuss from latest literature regarding stone disease, please enjoy.

img Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know?
Julieb-Jones Current Urol Rep. 2023
img 1'
https://pubmed.ncbi.nlm.nih.gov/37256486/ img

This kind of studies and papers have gain lots of attention as we need to be careful with the use of new laser technologies. This interesting and practical paper focuses on ways we can make our surgeries safer.

First, the use of small laser fibres allows for lower intra-renal temperature profiles. When using the fiber make sure it is always on the field of view (this is why we also recommend cutting the transparent tip). Ensure constant irrigation and constant flow. Also be aware of keeping avoiding very high-power settings during RIRS, specially at the expense of frequency.

We still need more evidence to suggest which laser is better for each case, but they have to be handled with care. Remember to always use low energy in the ureter. In summary, a must read.

img What to expect from the novel pulsed thulium:YAG laser? A systematic review of endourological applications
Ventimiglia E et al. WJU 2023.
img 1'
https://pubmed.ncbi.nlm.nih.gov/37682286/ img

The most recent innovation for laser lithotripsy is the pulsed Thulium YAG laser. As it has a mid-peak power is considered the “in the middle” laser that allows good performances as Holmium and Thulium fiber. This systematic review showed that there are only few papers that have evaluated such technology. The studies, most in-vitro, showed that compared to Ho:YAG it may potentially be equivalent regarding ablated stone weight. Also, an important fact is that temperatures have been equivalent to Holmium in such studies. In terms of coagulation, it also may be greatly effective (maybe better than Holmium) as lower peak power lasers coagulate better. What is clear is that we need more information regarding technical aspects and clinical studies.

img Pharmacological Management of Ureteral Stenterelated Symptoms: A Systematic Review, Bayesian Network Meta-analysis, and Meta-regression.
Hinojosa-Gonzalez DE. et al J Urol 2023.
img 1'
https://pubmed.ncbi.nlm.nih.gov/37428119/ img

We are aware that ureteral stents are related to high rates of bothersome. This study used Bayesian network meta-analysis that stratified the effectiveness of several medical therapies from the available evidence regarding pharmacological management of such symptoms. Although it is a high prevalent problem only 26 studies were adequate for evaluation.

This method that runs simulations revealed that the most effective drugs and dosages for urinary symptoms-combined was silodosin 8 mg+solifenacin 10 mg; for pain-combined silodosin 8 mg+solifenacin 10 mg; for sexual performance-tadalafil 5 mg. Combined silodosin 8 mg+solifenacin 10 mg+tadalafil 5 mg has the best general health scores while solifenacin 10 mg had the best work experience scores. Now you know which combinations are best for your patients.

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