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Hiller SC. et al., 2020: Frontiers of stone management

Hiller SC, Ghani KR.
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

PURPOSE OF REVIEW:
The surgical tool-box for urinary stone disease is growing. In this review, we discuss recent developments in the surgical management of urolithiasis, with emphasis on tailoring the management to the individual patient, and attention to the quality of care.

RECENT FINDINGS:
Shockwave lithotripsy remains a popular noninvasive treatment option for patients, with new data emerging on how to improve treatment outcomes as well as its limitations. Next-generation holmium lasers are expanding the role of dusting techniques for ureteroscopy but further studies are needed to assess safety and clinical outcomes. Advances in miniaturization and patient positioning are propelling percutaneous renal stone surgery toward endoscopic combined intrarenal and simultaneous bilateral surgery for patients with complex stone disease.

SUMMARY:
Stone management will be increasingly personalized to the unique qualities of the patient, stone, desired outcome, and available expertise and technology. Future studies assessing the quality of stone surgery should incorporate objective metrics to better delineate the success and cost of the different techniques available.
Curr Opin Urol. 2020 Jan;30(1):17-23. doi:10.1097/MOU.0000000000000698.

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Comments 1

Peter Alken on Thursday, March 12 2020 08:30

This is a short, well written overview on the current frontiers of all minimal invasive stone therapy techniques. I recommend reading the original article to those who want to know the current limits of the different procedures.
The advantages and draw-backs of the different techniques are precisely mentioned and referenced. An essential conclusion, slowly coming up in many minds is: “In the future, quality indicators such as patient reported outcomes, ED visit rates, or surgical reintervention rates, may provide an objective metric that will give us a better understanding of how good we are ... We recommend future studies incorporate a number of these objective metrics to better delineate the success and cost of the different techniques available.”

The term ESWL was originally introduced by Chaussy et al. (1)
I remember the time when the E from ESWL was removed by “we know-it better” urologists with the argument that the energy was created outside the patient and lithotripsy happened inside the patient (2,3); it is fun to read in this article a sentence which lets you think that the term ESWL could eventually be reinvented to avoid long phrases: “SWL, which has been the only extracorporeal technology for the treatment of kidney stones, …“

1. Chaussy Ch. et al. Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology, special issue May 1984 / 23, number 5 59-66
2. 11th World Congress on Endourology and ESWL, 9th Annual Research Symposium. Florence, Italy, October 20-23, 1993
3. 12th World Congress on Endourology and SWL 8th annual Frontiers in Endourology, 10th Basic Research Symposium. St. Louis, Missouri, December 2-6, 1994

This is a short, well written overview on the current frontiers of all minimal invasive stone therapy techniques. I recommend reading the original article to those who want to know the current limits of the different procedures. The advantages and draw-backs of the different techniques are precisely mentioned and referenced. An essential conclusion, slowly coming up in many minds is: “In the future, quality indicators such as patient reported outcomes, ED visit rates, or surgical reintervention rates, may provide an objective metric that will give us a better understanding of how good we are ... We recommend future studies incorporate a number of these objective metrics to better delineate the success and cost of the different techniques available.” The term ESWL was originally introduced by Chaussy et al. (1) I remember the time when the E from ESWL was removed by “we know-it better” urologists with the argument that the energy was created outside the patient and lithotripsy happened inside the patient (2,3); it is fun to read in this article a sentence which lets you think that the term ESWL could eventually be reinvented to avoid long phrases: “SWL, which has been the only extracorporeal technology for the treatment of kidney stones, …“ 1. Chaussy Ch. et al. Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology, special issue May 1984 / 23, number 5 59-66 2. 11th World Congress on Endourology and ESWL, 9th Annual Research Symposium. Florence, Italy, October 20-23, 1993 3. 12th World Congress on Endourology and SWL 8th annual Frontiers in Endourology, 10th Basic Research Symposium. St. Louis, Missouri, December 2-6, 1994
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