#20 Click here to see the previous editions April 27, 2024
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Hello and welcome to the Stone News, a newsletter where we discuss every two months the most recent and relevant studies in stone disease.

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Welcome to this April edition of Stone News, in which we discuss three important topics on stone disease.

First, we will discuss a metabolic index we could use to identify patients for high-risk formation. Second, we will review a very interesting evaluation on a hot topic, intra-renal temperatures when using high-power lasers, where the authors give some interesting tips to avoid it. And finally great insights and precautions for bilateral flexible ureteroscopy.

I hope that this edition of Stone News will help you to provide a better service to your patients.

img Basal metabolic rate and the risk of urolithiasis: a two‑sample Mendelian randomization study.
Lu Z et al. World Journal of Urology. Feb 2024.
img 2'
This article discusses the prevalence of urolithiasis and its impact on global health, emphasizing the need for effective prevention strategies. We know about the increased prevalence of urolithiasis due to metabolic syndrome-related disorders like obesity, diabetes, dyslipidemia, and hypertension. However, establishing a causal relationship using observational studies is challenging due to confounding biases.

To address this, the researchers used Mendelian randomization (MR), a method employing genetic variants as proxies for exposures to assess causal relationships. They conducted a two-sample MR analysis using large-scale genome-wide association study (GWAS) data to investigate the relationship between basal metabolic rate (BMR) and urolithiasis risk. BMR is defined as the number of calories you burn as the body performs the basal functions.

Their analysis indicated a negative association between BMR and urolithiasis risk, suggesting that individuals with lower BMR may have a higher risk of developing urolithiasis.

The study is innovative for using a large and new GWAS database and for being the first to reveal a causal relationship between BMR and urolithiasis risk. These results challenge previous observational studies, indicating that genetic variations and BMR might play crucial roles in urolithiasis development.

The findings suggest that BMR could be a measurable indicator to identify individuals at risk for urolithiasis, suggesting the potential for more aggressive preventive measures in individuals with low BMR.
img Temperature Measurements During Flexible Ureteroscopic Laser Lithotripsy: A Prospective Clinical Trial
Sørstrand Æsøy M et al. J. Endourology. April 2024
img 1'
The authors of this article explored one of the most concerning events in ureteroscopy nowadays, the thermal risks associated with laser lithotripsy in kidney stone surgery, specifically focusing on flexible ureteroscopic laser lithotripsy (RIRSL). The study examines the rise in intrarenal temperatures (IRT) during different laser power settings and their correlation with renal pelvic size. The key findings include that IRT increased significantly with higher laser power settings.

That peak temperatures were directly related to power settings, with thresholds of concern (43ºC) reached at only 20W and 30W. That renal pelvic size (measured by anteroposterior diameter) is inversely correlated with peak temperatures. That Higher power settings (≥20W) in a sheathless approach pose thermal risks, suggesting caution in choosing power levels to avoid thermal damage.

The study underscores the importance of considering renal pelvic anatomy when setting laser power during RIRSL, advocating for lower power settings (≤10W) to mitigate thermal risks, especially in patients with smaller renal pelves.
img Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones
Danilovic A. et al. World Journal of Urology. April 2024
img 2'
The article investigates the perioperative renal function changes following bilateral flexible ureteroscopy (RIRS) for kidney stones. It highlights the increased incidence of urolithiasis and a common problem seen in our clinic, bilateral stones needing treatment, sometimes leading to bilateral surgery. Bilateral RIRS is considered efficient in sparing resources and shows similar stone-free rates (SFR) and length of stay (LoS) compared to unilateral procedures. However, it may lead to more complications and emergency room visits.

The study conducted from 2016 to 2020 involved 30 symptomatic patients with bilateral kidney stones. It found that renal function decreased mainly on postoperative day 3 (POD3), with 46.7% and 23.3% experiencing > 20% and > 30% decrease in estimated glomerular filtration rate (eGFR), respectively. However, this reduction of eGFR was reversible.

Lower preoperative eGFR, higher ASA classification, and longer operative time (≥ 120 min) were identified as independent risk factors for acute renal function decline post-bilateral RIRS. Stone size was a predictor for longer operative time. The study suggests careful patient selection and monitoring to avoid acute renal failure post-bilateral RIRS, with implications for operative time management.
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