Nephrolithiasis: There are news

From stone formation to vacuum-assisted stone removal

Nephrolithiasis is a frequently treated disease in urology, assumed to have no further room for groundbreaking innovations. However, causal research and the vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) hint at new developments.

Nephrolithiasis is often an accompanying disease in people with severe overweight or metabolic syndrome (MetS). According to several studies, overweight people have a threefold increased risk of developing kidney stones. Although this connection has been postulated for a long time, very little is known about the underlying causes.

Stone formation in overweight people

A study presented at this year's EAU Congress in Barcelona examined the influence of fatty acid binding protein 4 (FABP4) on the stone formation rate. It was found that FABP4 was reduced in patients with a high stone load. In a mouse model, the researchers also confirmed that the downregulation of FABP4 directly contributed to stone formation in the kidneys.

Another study evaluated the influence of one or more metabolic syndrome indicators on stone formation. Again, it was clear that the more signs of MetS there were, the higher the risk of kidney stones in the patients concerned.

Kidney stones simply "vacuumed away"

In most cases, the stone formation can unfortunately no longer be prevented, as kidney stones are already present during the consultation. In the future, however, there could be an increase in the number of therapy methods with the vacuum-assisted mini PCNL (vmPCNL). The vmPCNL is executed as a mini PCNL. But unlike these, the vmPCNL forms a semi-closed circuit, which makes it possible to create a vacuum, with the help of which medium and stone fragments are simply extracted.

In their study, the scientists examined whether the new vmPCNL is safe and effective in a real-life collective of 60 patients. In their work, they confirmed the absence of fragments > 4 mm, one to three months after the operation. Imaging was performed by ultrasound or CT.

The results showed that 88.3% of the patients achieved kidney stones absence, with none of these patients requiring further treatment. The researchers determined the stone clearance in the CT because it is much more sensitive to smaller fragments than the standard ultrasound examination. It was also interesting to note that the vmPCNL could be used to "suck off" stone sizes up to < 8 mm. The new method also appears to be safe because only about 3.3% of the patients needed a blood transfusion and 10% had an infection.

These initial preliminary results on the use of vmPCNL in practice suggest that the new method is effective and safe for nephrolithiasis patients. In addition, the time required for the intervention was significantly reduced compared to the standard PCNL.


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