LELR 23 Special Edition Click here to see the previous editions January 28, 2023
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Hello and welcome to the Stone News by Devicare, where we discuss every 2 months the most recent and relevant studies in stone disease.

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Hello Stone fans!, welcome to this special edition of Stone News.

In this special edition of Stone News, I would like to cede the honour to Dr. Andrés Kanashiro (Fundació Puigvert, Barcelona) who will highlight the most important topics during the last Spanish Meeting of Lithiasis and Endourology, Laparoscopy and Robotics Groups was held in Zaragoza (LELR 2023).

I hope you enjoy this special edition to keep you updated with the most recent and relevant hot topics on Kidney Stones Disease.

Dr. Andrés Kanashiro

On the 19th and 20th of January, The XXXII Spanish Meeting of Lithiasis and Endourology, Laparoscopy and Robotics Groups was held in Zaragoza. This meeting concentrated pathologies and topics of interest for the urological community, and one of the most important topics was urolithiasis and the whole spectrum of its management.

Among the various medical issues of urolithiasis that were discussed, the most important ones, in my opinion were the following:

img General Plenary: Final conclusions on ENIUS.
Dr. Soria
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This is a worldwide working group with various specialists, physicians, engineers and bioengineers working collaboratively to identify improvements in the design and management of double J. Four important messages identified to improve the quality of life of patients with double J were mentioned: Avoiding the distal end to go beyond the midline of the trigone, 4.8-5 CH double J are better tolerated than larger diameter, silicone is better tolerated and reduces the rate of encrustation and finally the importance of urinary pH monitoring using the portable pH meter in patients with double J to avoid clinically significant calcification.

img Poster session: Methods of urinary pH monitoring for patients with lithiasis pathology: A systematic review of the literature.
Dra. Sanz-Gómez, Dr. Angerri, Dr. Emiliani, et al.
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The importance of urinary pH monitoring in the management of urolithiasis is indisputable with current evidence, however the method of doing so is not entirely clear, especially as in the past test strips have been used. This study identifies the low accuracy of the test strips, which does not allow for guidance in medical treatment decisions for the patient. On the other hand, it was identified that portable electronic pH-meters are more accurate with less margin of error for the measurement of urinary pH, as well as being a simple method for patients to use. Therefore, it is concluded, based on current evidence, that portable pH meters are accurate, easy to use and cost-effective, resulting in more effective medical management of the lithiasis patient.

img Implications of alterations in 24-hour urinary biochemistry in JJ catheter encrustation.
Dra. Costa-Bauzà, Dr. Grases, Dr. Pieras, et al.
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Double J catheter encrustation is a frequent complication that can condition the appearance of other more serious complications. This study determined the relationship between urinary metabolic conditions and the formation, severity and composition of encrustation on double J catheters in lithiasic patients. It was found that urinary conditions, such as urinary pH, diuresis, calciuria, uricosuria, oxaluria and phosphaturia, as well as dwell time play a critical role in JJ catheter fouling formation, severity and composition. Analyzing this result, it can be concluded that reducing the dwell time of double J in lithiasic patients is paramount, however, as long as they need to be worn, identifying the metabolic disturbance and providing specific treatment may allow double J catheters to remain free of (clinically significant) calcifications for a longer period of time.

img Inhibitory activity of uric acid crystallization by metabolites of theobromine in urine.
Dra. Calvó, Dr. Grases, et al.
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Uric acid lithiasis accounts for 10% of all lithiasis. The classic treatment consists of alkalinization and/or reduction of purine intake (or xanthine oxidase treatment). Theobromine is a methylxanthine, present in large quantities in cocoa, which has been shown in previous studies to inhibit uric acid crystallization. Theobromine is metabolized in the body and excreted into 7-methylxanthine (7MX, 36%), 3-methylxanthine (3MX, 21%) and 3.7 dimethylacidouric acid (3-7 DMUA, 1.3%), with 21% remaining unchanged. The study assessed the action of theobromine and its metabolites in inhibiting uric acid crystallization, finding that the combination of 7- methylxanthine and theobromine potentiates this action synergistically, with the action being greater at higher concentrations.

img Clinical trial on the use of Canoxidin® in the prevention of Foley catheter obstruction.
Dra. Julià, Dr. Grases, et al.
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Patients with bladder catheters may suffer from catheter obstruction, which is related to bacteriuria and infection associated with catheterisation. Bladder catheters were collected from catheterized patients, all of whom provided a baseline catheter and others after treatment with placebo or Canoxidin®. Results assessed by light and scanning electron microscopy showed a decrease in phosphate deposits in patients treated with Canoxidin®. Although the results obtained were obtained with a very small sample, they open a very interesting field on the effect of Canoxidin® on bladder catheters and other types of urinary diversions in contact with urine (double J catheter and nephrostomy catheters), which merit further studies.

img Precision medicine in lithiasis.
Dr. Cepeda. Dra. Torra-Balcells, Dr. Angerri.
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In this section, the importance of individualized studies of urolithiasis by means of metabolic studies and, if necessary, genetic studies to identify possible genes associated with this pathology was discussed. From the surgical point of view, the importance of adapting the endourological material to percutaneous surgery according to the patient's renal anatomy and the characteristics of the lithiasis to be treated was discussed, with the possibility of choosing between the various mini-perc diameters and, if necessary, using standard diameters or maximizing them. The need to assess each case individually and offer the various tools available for the treatment of urinary lithiasis, according to the patient's preferences, renal anatomy and characteristics of the lithiasis to be treated, thus optimizing results and patient satisfaction, with fewer complications, was also discussed.

img Homage to Professor Gabriel Valdivia.
Dr. Ibarluzea.

Keynote lecture.
Dr. Valdivia.
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Probably the most emotional moment of this meeting, Dr. Gabriel Valdivia received the general and incessant applause of the attendees, after giving a master lecture. He is one of the most notable examples of Spanish urology, as he humbly and selflessly studied and worked in the field of urinary lithiasis, his greatest recognition lies in changing the paradigm of the percutaneous approach to lithiasis, previously carried only in the prone position, and describing the supine position (Valdivia`s Position) with different advantages for urologists, anesthesiologists and patients. Dr. Valdivia represents the "urologist" that all urologists strive to be.

img 3rd edition of the clinical case competition about the medical management of kidney stones with Lit-Control®
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Encouraging clinical research, Devicare organized the 3rd Edition of the Clinical Case. Competition related to the non-surgical clinical management of Renal Lithiasis. Dr. Rosa María Gras from the Hospital General Universitario de Valencia was the winner of the competition whose prize is the registration to the EAU Congress 2023 with flight and accommodation included. In addition, among all the clinical cases presented, the scientific committee will select the best ones to be published in a compendium in English by Devicare for international distribution.

img Devicare's contest to win T&T 2023 course in Turin.
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Also, during the Meeting, Devicare organized a contest whose prize was the attendance to the Technology & Training (T&T) 2023 Course, organized by Dr. Cesare Scoffone to be held in the city of Turin, this course is a worldwide reference as it covers very comprehensively the various topics of endourology. The lucky winner was Dr. Andrea Palacios from Hospital Clínico Universitario Lozano Blesa de Zaragoza. We hope she enjoys and learns a lot.

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