Veser J. et al., 2021: Innovations in urolithiasis management
Veser J, Jahrreiss V, Seitz C.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Purpose of review: This review provides a forecast about ongoing developments in the management of urolithiasis with a potential to challenge the current standard of care. We therefore emphasized innovative technology, which might be considered still experimental in the daily clinic or needs further clinical validation, but harbors the great potential to become a game changer for future stone management.
Recent findings: Especially in the endoscopic stone treatment, we observed a multitude of groundbreaking technical innovations, which changed our treatment algorithms over the last decades. Some of this technology already found its way into daily practice. Others like artificial intelligence, burst wave lithotripsy, smart laser systems or gene therapy may not be standardized yet, but have the potential to further revolutionize current practice. Besides those technical features, we included innovations in prevention and diagnostics, as well as patient expectations and patient satisfaction into the analysis. A proper metaphylaxis and patient communication seems to be essential for a long-lasting treatment success.
Summary: The combination of technical innovations, improved stone metaphylaxis and proper patient communication presents the cornerstone of future kidney stone management.
Curr Opin Urol. 2021 Mar 1;31(2):130-134. doi: 10.1097/MOU.0000000000000850. PMID: 33470686
This short article is a brief overview of novel methods of relevance for current and future management of patients with urolithiasis.
1. Artificial intelligence (AI) might be of importance as a method for in vivo determination of the chemical composition of stones.
2. Burst wave lithotripsy (BWL) is coming up at the horizon as a method for high-frequency non-invasive disintegration of stones. The first successful clinical disintegration of stones with BWL was carried out and published in 2020. It is assumed that BWL in the future might replace SWL for many stones. BWL, however, is not yet available for clinical use.
3. In terms of recurrence prevention improved genetical tools like CRISPR might be clinically useful but so far only for diagnostic tests and workup.
It is particularly one sentence in this article that deserves to be quoted: “Although the physicians tend towards more invasive treatment options, in order to achieve a stone-free status, a significant amount of patients favor the least invasive or painful treatment option first or want to avoid operation and general anesthesia”. [From Raja et al in Urolithiasis 2020; 48:227-234].
This dilemma needs to be seriously considered and selection of the most appropriate treatment is currently pushed into focus when the most rational approach must be selected to deal with the huge number of stone-patients in need of stone removal once the covid-19 pandemic has been successfully defeated.