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Welcome, Stone Fans, to this Fall edition of Stone News! Today, we will discuss three recent papers from the latest literature. First, we will explore the importance of early detection, metabolic evaluations, and treatment of patients with cystine stones. Second, we will review new technologies, such as miniaturization of ureteroscopy and aspiration. Finally, we will discuss the importance of stone culture to avoid complications during RIRS. We hope you enjoy this edition of Stone News.

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Cystinuria is a rare genetic leading to severe and recurrent kidney stone disease. It affects only 1% of stone formers but poses unique challenges due to its early onset and high recurrence rate. Patients often develop large stones, sometimes leading to kidney failure if not properly managed. Early diagnosis, ideally in childhood or with a strong family history, is crucial to reducing complications through dietary adjustments and medications. However, this study found that diagnosis is often delayed, with many patients going years without proper treatment or information.

The study examined 28 adult cystinuria patients treated at four tertiary centers. It found that many did not receive metabolic evaluations before treatment, and delays in starting alkalinization therapy, a key treatment, were common. Only a fraction received chelating agents, with most patients reporting poor instruction or taste aversion as reasons for non-compliance. Many patients turned to herbal remedies, and they reported high levels of fear, particularly concerning kidney loss and dialysis.

Patients with cystinuria face frequent medical procedures, exposure to high radiation levels during imaging, and the burden of managing a chronic condition. The study emphasizes the need for timely diagnosis, specialized care, constant metabolic evaluation, including medication for urine alkalinization and pH monitoring, and improved patient education to enhance the quality of life and reduce the risk of severe complications.

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The article explores how minimally invasive methods are revolutionizing the treatment of kidney stones, shining a spotlight on the latest 7.5 fr scopes. It's pretty exciting to see tools like TFL and specially designed ureteroscopes that literally aspirate dust, making surgeries more accurate, safer, and cleaner. However, it's still tough to get every tiny stone out in one go, especially with big stones or when stone dust clouds the view.

In a study that caught many eyes, researchers took a closer look at the DISS 7.5Fr Pusen ureteroscope, which is like a Swiss Army knife for kidney stone removal. It's flexible, comes with its own vacuum cleaner to suck up debris, and aims to keep things clear and pressure low inside the kidney. Out of 57 patients who underwent the procedure using this gadget, a whopping 84.2% came out stone-free with hardly any complications and quick surgery times to boot.

The authors praised it for being easy to handle, providing clear views, and its suction feature, though they did point out that it struggles a bit with the bigger chunks because of its slim design. While the DISS 7.5Fr Pusen ureteroscope has shown promising results, the medical community is eager to see more research, especially on tackling those larger stones.

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The study investigates the role of stone culture (SC) in predicting postoperative sepsis after RIRS. We know ureteroscopy carries risks such as sepsis, with rates ranging from 0.5% to 11.1%. The study compares SC results with midstream urine culture (MSUC), traditionally used preoperatively, to assess which better predicts sepsis.

The research included 293 patients undergoing F-URS between 2022 and 2023. Of these, 32 patients had positive SC results. Key findings revealed that patients with positive SC were older, had more comorbidities (e.g., diabetes), and were more likely to have had a nephrostomy or ureteral stent preoperatively. Importantly, these patients faced a higher rate of sepsis (3.1%) and septic shock (9.4%), compared to those with negative SC. MSUC was found to be an unreliable predictor of postoperative infection, as only 46.2% of patients with positive SC also had a matching MSUC pathogen.

The study emphasizes the importance of SC, especially in patients with factors such as diabetes, recent urinary infections, or preoperative stents, which significantly increase the likelihood of postoperative infection. While SC may be challenging to perform in some cases (due to stone dusting during surgery), it is a critical tool for guiding postoperative antibiotic use and preventing major infectious complications.