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Dear Stone Fans. Get ready for a summer tour of cutting-edge kidney stone research. These three articles dive into smarter urine pH monitoring, we will discuss how FANS is challenging the current limits of URS, and the rise of robotics in urology. From digital pH meters to flexible scopes and futuristic robotic platforms, the future of stone management is here—and it’s exciting. Let’s see how technology is transforming patient care, one stone at a time.

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This article reviews the effectiveness and cost-efficiency of portable digital pH meters, such as Lit-Control^® pH Meter 2.0, versus traditional dipstick tests for monitoring urine pH in patients prone to recurrent kidney stones. 

The study systematically analyzed 13 studies with 2,801 participants, finding that portable digital pH meters are more accurate, reliable, and sensitive than dipsticks, offering finer measurement and lower systematic bias. 

Cost analysis revealed that digital meters not only provide better clinical outcomes—preventing more stone episodes and improving quality-adjusted life years—but also reduce overall costs compared to dipsticks. 

The authors conclude that adopting portable digital pH meters in clinical practice could improve patient care, reduce stone recurrence, and lower healthcare costs, recommending their inclusion in clinical guidelines and reimbursement policies for broader use.

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The trial found that FANS f-URS was noninferior to mini PCNL for immediate stone-free rate (84% vs 85%). Three-month stone-free rates were also similar between groups (90% vs 92%). We need to remember that this study was done with highly experienced surgeons, which may limit generalizability to lower-volume centers.

Where the techniques diverged: FANS f-URS took notably longer (88 vs 59 minutes on average) but came with meaningful recovery advantages. It caused less blood loss, lower transfusion rates, fewer serious bleeding, less postoperative pain, a much shorter hospital stay (1 day vs 4 days), and better quality-of-life improvement at one month. Overall complication rates didn't differ significantly, but moderate-to-severe complications (Clavien-Dindo grade II or higher) were more common with mPCNL.

These are promising results for FANS, although we still need to be careful while adopting a new technology on keeping safe OR times and knowing the  limitations. For example this study is too short to capture late complications like ureteral stricture. But we are definitely seeing the trend of FANS taking over some Mini-PCNL cases.

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This article presents a preliminary study on the MONARCH™ Platform, an FDA-cleared robotic system designed to improve PCNL for complex kidney stones. 

The study involved 15 patients across two major institutions in the US. Results showed that the MONARCH™ Platform enabled urologists to achieve successful percutaneous access in all cases using electromagnetic guidance through flexible ureteroscopy, with a high rate of single-attempt access. 

This technology allowed urologists to independently and efficiently perform complex procedures, offered flexibility in surgical approach, and provided ergonomic benefits with a handheld controller. Nonetheless the stone-free rate (≤4 mm fragments) at 30 days post-procedure was 50%. The average OR time was 194 minutes (ranging from 108 to 314 minutes). Complications were minimal, and most patients reported significant improvements in pain and quality of life by 90 days. Only one serious event was reported: intrabdominal fluid accumulation that required drainage. 

The study concludes that the MONARCH™ Platform is feasible to use, and that electromagnetic guidance has potential for urologists to obtain PCNL access. This represents another step toward the possible robotization of our techniques.