This study examined the compliance rate and results of metabolic evaluation (ME) in surgically treated patients with kidney stones. Although ME is critical for identifying underlying metabolic abnormalities and guiding personalised treatment, only about 10-20% of patients with kidney stones undergo ME.

Data from 11,979 patients with stone composition analysis were analysed. Of these, 59% had at least one urine sample and 39% had a complete urine sample.

Demographic factors such as female gender, age between 60 and 69 years, Jewish ethnicity, and high socioeconomic level increased the likelihood of a complete urine collection. Cystine and calcium phosphate stone formers had the highest rate of complete urine collection. Of those with complete collection, 63% had at least one metabolic abnormality, with hypercalciuria and hypocitraturia being the most common (24% each).

Although surgically treated stone patients are more likely to complete ME, the majority do not undergo a complete evaluation, suggesting the need for further patient education.

The aim of this study was to investigate current practices and perspectives on kidney stone analysis among urologists and urology residents worldwide.

An online survey based on the EAU kidney stone management guidelines was distributed from October 2022 to February 2023.

A total of 351 urologists (75.4%) and 115 urology residents (24.7%) completed the survey. The results showed that 49.1% of participants considered kidney stone analysis to be of the utmost importance in every patient, and 91.8% believed it could change the management of kidney stone disease (KSD). However, only 62.3% adhered to the guidelines, and while 44.7% aimed to perform stone analysis in first-time stone formers, a minority did not send stones for analysis at all. Urologists with an additional subspecialty in endourology were more likely to perform stone analysis.

It was concluded that although the majority of urologists value stone analysis in the management of kidney stones, there are variations from the EAU guidelines in practice. Bridging the knowledge gap, promoting collaboration and improving the logistics of stone analysis are essential to improve the quality of care for patients with kidney stones.

 

This is a multicentre study to evaluate the intra- and perioperative stone-free rate (SFR) and complications within 24 hours after retrograde intrarenal surgery (RIRS) for solitary renal stones in normal renal anatomy using the flexible and navigable suction sheath (FANS) in a global multicentre study.

Prospective data were collected from 15 countries with ethical approval from the Asian Institute of Nephrology and Urology, Hyderabad. Inclusion criteria were adults with solitary renal stones and normal anatomy undergoing RIRS with FANS. Baseline and operative characteristics were recorded, and a non-contrast CT scan was performed within 24 hours of surgery to assess SFR, complications and exit strategy. Analysis included univariate and multivariate analyses for 100% SFR.

Results from 142 cases showed a median stone volume of 1165 mm³, with FANS and disposable scopes being used preferentially in 44.4% and 77.5% of cases respectively, and under general anaesthesia in 80.3% of cases. The most commonly used laser was TFL and only 15.5% of cases required stone fragmentation with a basket. Mean laser and total ureteroscopy times were 16.5 and 35.5 minutes respectively, with a total operative time of 48.5 minutes. The majority of cases (84.5%) received a DJ stent placement, 9.2% had an overnight ureteral catheter and 6.3% had no drainage.  Complications were low with CD 1 and II, fever (7%) and ureteral injury grade I (n=4), grade II (n=1) requiring stenting. The overall SFR was 96.5%, with reintervention planned in 4 out of 5 patients with fragments >4mm.

In conclusion, using a CT scan 24 hours after RIRS with FANS, the study demonstrated a high immediate single-stage SFR with minimal complications. FANS effectively navigated the PCS and used suction to remove fragments and dust, reducing the need for baskets and unnecessary stenting.