The role of the intestinal microbiome in influencing the composition of the urine has been explored resulting in data suggesting that it affects kidney stone incidence. There is increasing concern that the ‘Western’ diet and lifestyle have altered the genetic composition and metabolic activity of the intestinal microbiome. The effects of these changes in the bacterial populations have been associated with the increasing incidence of diseases such as obesity, coronary vascular disease, allergies, and metabolic syndrome. These effects make the possibility that the gut microbiome also affects absorption and secretion of solutes relevant to kidney stone formation.

Eubacterium was inversely correlated with oxalate levels and Escherichia inversely correlated with citrate levels. Whether these differences in bacterial abundance seen in stone formers and controls are causative in the pathway of stone formation, or secondary to other variables such as antibiotic exposure or diet, is uncertain. Such broad characterizations of the microbiome will need more extensive investigations to link to specific solutes that compose kidney stones and specific agents affecting the crystallization process.

Urine pH plays a critical role in stone composition, acidic urine promotes uric acid stones, whereas alkaline urine promotes phosphatic and struvite stones. But in the narrow range between 5.5-6.2 there is an area; called the protective zone, where precipitation of the main components of Kidney Stones is difficult to occur.

Devicare has developed the most comprehensive and complete treatment for Kidney Stones offering a personalized stone approach to treat stone-former patients.

• Lit-Control® pH Up: Alkalinize the urine pH and inhibits the crystallization of uric acid.
• Lit-Control® pH Balance: Inhibits the crystallization of calcium and protects the kidney from oxidative stress.
• Lit-Control® pH Down: Acidify urine pH and inhibits the crystallization of struvite.
• Lit-Control® pH Meter: first medical device certified that allows a precise measurement and control of urinary pH in less than 30 seconds.

In addition, for the first time ever, Devicare has presented myLit-Control App a free mobile app that aims to contribute to the prevention of Kidney Stones Disease by reducing the burden of the disease and increasing the patient’s adherence through monitoring of pH, water intake and treatment adherence. Furthermore, Mr. Garganta encouraged all the attendees to contact Devicare to conduct new studies and generate more scientific evidence around Lit-Control.

Urolithiasis remains one of the most frequent urological diseases worldwide and its treatment has undergone several innovative progresses. After the introduction of minimally invasive endourological surgery in the last century, robotic systems are now emerging. For urolithiasis, new robot endourological approaches, such as the Roboflex Avicenna system for fURS, are possibly the most innovative solutions for complex cases. These robotic systems have already shown their potential in early clinical trials.

Various new technical improvements, such as real-time three-dimensional visualisation increase safety and usability in percutaneous interventions for stone treatment. Robotic systems are continuously replacing classic laparoscopy and open surgical operations in stone surgery. The evidence for the increased benefit of robotic stone surgery compared to existing treatment options is increasing, but data are still insufficient.

Prospective randomised controlled studies are necessary to verify the benefit of this novel technology for the treatment of urolithiasis. Nanotechnology will also be part of next-generation treatment options and is of great interest to both scientists and surgeons.

The laser Holmium:YAG beam involves fundamental design constraints compared to the Thulium laser. These differences can result into potential advantages in favour of the Thulium fiber laser: four-fold higher absorption coefficient in water, smaller operating laser fibers (50-150 µm core diameter), lower energy per pulse (as low as 0.025 J), and higher maximal pulse repetition rate (up to 2000 Hz). The Thulium fiber laser overcomes the main limitations of the Holmium:YAG laser relating to lithotripsies.

This innovative laser technology seems particularly advantageous for ureteroscopy and may become an important milestone for kidney stone treatment It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization.

The SuperPulsed Thulium fiber laser, has been reported to be thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintained intraoperatively. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting.