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Dear Stone fans. In this summer edition, we spotlight game-changing advancements in kidney stone management! Discover how ultrasonic propulsion is revolutionizing the clearance of stubborn stone fragments, offering a non-invasive solution with impressive success rates. Learn about critical dietary insights that can help prevent stone recurrence, empowering patients with lifestyle changes. 

Lastly, delve into the promising outcomes from a multicenter study on innovative suction ureteral access sheaths, enhancing safety and efficiency in retrograde intrarenal surgery. Stay ahead in kidney stone health with these groundbreaking findings—transforming both treatment and prevention!

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This randomised controlled trial evaluated the effectiveness and safety of ultrasonic propulsion (UP), a non-invasive technique involving the use of focused ultrasound waves to dislodge residual kidney stone fragments following lithotripsy. 

Twenty-four adult participants with fragments smaller than 5 mm were randomised to receive either the UP procedure or no additional treatment. During the three-week follow-up period, 83% of patients who underwent UP reported passing fragments, compared to just 17% of those in the control group. Imaging confirmed a reduction in stone burden in 75% of the treatment group versus 9% of the control group. The procedure was performed in a clinic setting without anaesthesia, and no serious adverse events were reported. Mild, self-limiting side effects such as discomfort and haematuria occurred at similar rates in both groups. 

These results replicate the findings of a previous study, demonstrating that UP is a safe, effective and easily trainable method of enhancing the passage of stone fragments and potentially reducing long-term complications. The study supports UP as a promising outpatient solution for managing residual kidney stones, complementing other ultrasound-based technologies such as burst wave lithotripsy.

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Kidney stones, or nephrolithiasis, affect about 10-15% of adults globally, primarily due to an imbalance in crystallization inhibitors and promoters, with calcium oxalate stones being the most common. 

This case-control study examined the impact of dietary habits on kidney stone formation among 600 patients diagnosed with stones, alongside a control group of 50 healthy individuals. Key risk factors identified included low fluid intake, excessive meat consumption, and high acid load diets, while plant-based diets could lower the risk. The study emphasizes that dietary modifications can serve as effective preventive measures against kidney stones. 

Patients should be encouraged to increase fluid intake, limit animal protein, and adopt plant-based eating patterns to reduce the likelihood of stone formation and recurrence. It is essential to maintain consistent patient follow-up to monitor dietary changes and kidney health, along with regular urine pH monitoring to evaluate stone risk. Moreover, recommending supplements to manage calcium and nutrient levels can further decrease risk. 

Overall, the findings highlight the importance of tailored dietary counselling by healthcare professionals to help prevent kidney stones through lifestyle changes.

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This prospective, multicenter global study evaluated the use of flexible and navigable suction sheaths (FANS) in RIRS for kidney stones, aiming to improve stone-free status  rates and reduce complications and reinterventions. 

Enrolling 394 adult patients with normal renal anatomy, the study found that FANS could be successfully deployed in all cases, with surgeons able to navigate the sheath to most parts of the kidney. The single-stage complete stone-free rate (grade A) was 57.4%, and combining grade A and B (clinically insignificant residual fragments ≤2 mm) reached 97.2%, demonstrating excellent efficacy even in larger stones or difficult locations. The use of thulium fiber laser was associated with better outcomes, while the suction-assisted technique allowed effective real-time evacuation of dust and fragments, reducing operative and laser times. 

Safety was excellent, with low rates of mild complications, no sepsis, minimal postoperative pain, and a very low reintervention rate of 2.8%. Notably, FANS use helped minimize stent placement, potentially reducing stent-related discomfort. 

Although some limitations exist, including no control group and exclusion of anatomical anomalies, the study suggests that FANS represents a significant technological advancement that can enhance RIRS by improving stone clearance and patient safety, potentially becoming a new standard in kidney stone management.