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.

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.

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.

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.

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.