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Hello and welcome to the Stone News by Devicare, where we
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Hello Stone fans!, welcome to this special edition of Stone News.
I am Alejandra Bravo-Balado, 5th year Urology Resident at Fundació Puigvert. Here I present some highlights from the 2023 AUA Annual Meeting, which took place in Chicago from April 28 to May 1.
I hope you enjoy this special edition to keep you updated with the most recent and relevant hot topics on Kidney Stones Disease.
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![img](img/doctor.png) |
Development and Initial Clinical Experience of a Novel Endoscopic Robotic Platform. Monarch PCNL Presented by Dr. Landman, at the Engineering and Urology Section of the Endourolgical Society (EUS) Session.
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Dr. Landman presented the 2º case (the 1º case was performed by the same group on January 2023) of a robotically assisted electromagnetic-guided percutaneous access and mini-percutaneous nephrolithotomy (PCNL) procedure using the Monarch system, performed on February 24th, 2023, in a 35-year-old female with history of cystinuria and a 34mm 667 HU left partial staghorn stone.
This system consists of a 3-arm platform and employs irrigation and aspiration circuits, while the ablation is performed using a high-power Holmium-Yag laser via an ureteroscope. The patient is placed in a modified lithotomy position and the surgeon uses a joystick to manage the robotic instruments. This is certainly a novelty in the endourology field that could potentially decrease complications associated with percutaneous puncture and improve stone free rates, but prospective clinical data is pending.
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MP10-15: Alkaline Water: Help or Hype for Uric Acid Stone Patients? Abstract presented by Dr. Piedras et al. At the Stone Disease: Medical and Dietary therapy poster session.
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Urinary alkalinization therapy is frequently prescribed in patients with uric acid nephrolithiasis but given low compliance there has been interest in alkaline water as a potential therapeutic alternative; however, for any fluid to have an alkalinizing effect on urine, it must contain organic anions such as citrate and bicarbonate.
The authors analyzed five commercially available alkaline water products to assess their electrolyte and organic anion composition which was then contrasted with the alkali content of potassium citrate, sodium bicarbonate and other over the counter organic and synthetic beverages and found that the pH levels of the five alkaline waters ranged from 9.69-10.15; however, the electrolyte content was minimal, and the physiologic alkali content was < 1 mEq.
They concluded that, for uric acid stone patients, commercially available alkaline water has negligible alkali content and thus would likely provide no added benefit over consumption of an equal volume of tap water. These results are interesting because they contrast with a widely expanded popular belief that alkaline water should be recommended to stone patients.
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MP10-09: The Real-World Effectiveness of Preventive Pharmacological Therapy. Abstract presented by Dr. Hollingsworth et al. at the Stone Disease: Medical and Dietary therapy poster session.
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This is an observational study aimed to determine whether preventive pharmacological therapy led to fewer symptomatic kidney stone events, requiring emergency department visit, hospitalization, or surgery.
They included a cohort of Medicare enrollees who had a 24-hour urine collection processed by a large central laboratory (2011-2016) and linked the data with their pharmacy and medical claims. Including a total of 7,230, they found that, compared to untreated patients, those prescribed concordant therapy and adhered to their medication had a 38% lower hazard of emergency department visit (p < 0.01) and a 46% lower hazard of hospitalization (p=0.04). This study is very interesting because it strengthens the evidence available for preventive pharmacological therapy use, providing real-world data on its clinical effectiveness.
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![img](img/doctor.png) |
LBA01-14: Break WaveTM Lithotripsy for Urolithiasis: Results of the First-In-Human International Multicenter Clinical Trial. Abstract presented by Dr. Chew et al. at the Late-breaking Abstracts I – Benign..
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Urinary alkalinization therapy is frequently prescribed in patients with uric acid nephrolithiasis but given low compliance there has been interest in alkaline water as a potential therapeutic alternative; however, for any fluid to have an alkalinizing effect on urine, it must contain organic anions such as citrate and bicarbonate.
The authors analyzed five commercially available alkaline water products to assess their electrolyte and organic anion composition which was then contrasted with the alkali content of potassium citrate, sodium bicarbonate and other over the counter organic and synthetic beverages and found that the pH levels of the five alkaline waters ranged from 9.69-10.15; however, the electrolyte content was minimal, and the physiologic alkali content was < 1 mEq.
They concluded that, for uric acid stone patients, commercially available alkaline water has negligible alkali content and thus would likely provide no added benefit over consumption of an equal volume of tap water. These results are interesting because they contrast with a widely expanded popular belief that alkaline water should be recommended to stone patients.
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![img](img/doctor.png) |
PD28-03: Efficacy and Safety of a Magnetic Hydrogel for Stone Fragment Removal: An In Vitro and In Vivo Study. Abstract presented by Dr. Massana et al. at the PD28: Stone Disease: Surgical Therapy (including ESWL) III.
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It is widely known that residual stone fragments that do not pass after ureterorrenoscopy contribute to recurrence. The authors developed MagSToNE, an integrated stone fragment removal system consisting of a magnetic hydrogel to coat and magnetize stone fragments and a magnetic wire for extraction.
They loaded stone fragments (< 3 mm) in an ex vivo kidney model to compare ureteroscopic removal time and efficiency using MagSToNE and a conventional basket. In the in vitro model, they found that MagSToNE provided a faster (up to 57 %) and more efficient approach for extraction of kidney stone fragments than conventional basketing and also demonstrated its feasibility in an in vivo porcine model. I believe this is a promising tool to render patients stone free during ureteroscopy, although in-human models studying efficacy and safety are still pending.
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It has been an honor to attend the EAU 23 and to have the opportunity to meet high-level people and lectures. It was an amazing experience and an important motivation to continue with my professional training.
Thank you again Devicare.
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