#18 Click here to see the previous editions December 16, 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 winter edition of Stone News. In today’s newsletter, we will delve into three recent and highly pertinent papers concerning stone disease.

Firstly, we'll explore the metabolic aspects of calcium oxalate stone formation in the elderly population. Next, we'll examine the perceived advantages of pre-stenting in anticoagulated patients undergoing RIRS. Finally, we'll delve into a systematic review focusing on patients’ preferences regarding stone treatment. My hope is that these insights offer new perspectives beneficial to your stone patients. Please enjoy!

img Drivers of calcium oxalate stone formation in the octogenarian population
Khargi R, et al. World J Urol. 2023
img 1'
https://pubmed.ncbi.nlm.nih.gov/37847263/ img

As the population's longevity increases annually, we frequently encounter elderly patients in our departments seeking advice for their stone disease. This vulnerable and occasionally marginalized population might encounter challenges in follow-up and metabolic assessments. This study conducted a retrospective evaluation of metabolic assessments in octogenarians to identify potential specific metabolic profiles and preventive therapies.

Data from patients with calcium oxalate stones and 24-hour urine studies were gathered and categorized by age. The elderly population, specifically those over 80 years old, exhibited a distinct metabolic profile characterized by hypocitraturia, low urine pH, and reduced urine volumes compared to younger patients. This observation aligns with the common occurrence of dehydration in elderly patients. Other parameters such as hypercalciuria or hyperoxaluria tended to decrease.

The authors proposed a straightforward regimen for these patients, suggesting increased hydration, elevated consumption of fruits and vegetables, and low-dose alkali therapy such as potassium citrate.

img Patient’s preferences: an unmet need by current urolithiasis guidelines: a systematic review.
Pauchard F et al. WJU 2023.
img 1'
https://pubmed.ncbi.nlm.nih.gov/37924335/ img

The article explores the shift from traditional doctor-driven decisions to shared decision-making (SDM) involving patients actively in treatment choices.

The study conducted a systematic review that highlighted a clear patient preference for less invasive treatments, particularly favoring SWL over URS or PCNL. Physicians played a pivotal role in guiding these choices, with up to 85% of patients relying on their recommendations.

However, there was a disconnect between patient preferences (SWL) and the treatment modalities widely practiced (URS). This discrepancy might stem from varying factors like physician recommendations, equipment availability, and real-world efficacy rates differing from trial outcomes.

img The Effect of Pre-Stenting on Bleeding-Related Complications Following Ureteroscopy in Patients on Anticoagulation or Antiplatelet Therapy
Berger JH. et al WJU 2023.
img 1'
https://pubmed.ncbi.nlm.nih.gov/37675902/ img

There is a large amount of patient with the use of anticoagulation (AC) or antiplatelet (AP) encountered in RIRS. Despite previous recommendations by the guidelines endorsing the continuation of anticoagulation during RIRS, concerns remain about inconsistent guidelines and potential bleeding risks.

To investigate the impact of pre-stenting on bleeding complications during RIRS in patients on AC/AP therapy, a multi-institutional retrospective study was conducted analysing 8614 patients.

The findings indicated that pre-stenting did not significantly reduce bleeding complications in the combined AC/AP cohort. However, within the AP-only group, pre-stenting was associated with fewer intraoperative bleeding incidents, reduced reoperation rates, and a trend towards lower overall complication rates within 30 days post-surgery.

Notably, while this study supports the benefits of pre-stenting in AP therapy patients, it did not find the same advantages in patients using AC or a combination of AC and AP therapies. This understanding would aid urologists in optimizing patient care and minimizing bleeding complications during these procedures.

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