During the past 3 decades, the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy. The development of this instrument as well as ancillary equipment such as baskets, graspers, and others, and improvements in lithotripsy with Holmium: YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors. The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

Objective: To evaluate a portable electronic pH meter and to put its accuracy in perspective with reagent strips read by a layperson, a healthcare professional, and an electronic reading device. Materials and Methods: Based on a preanalysis on 20 patients, a sample size of 77 urine aliquots from healthy volunteers was necessary to obtain sufficient study power. Measurements of urinary pH were obtained by use of reagent strips, a portable pH meter and a laboratory pH meter (gold standard). Reagents strips were read by a professional experienced in interpreting strips, a layperson, and an electronic strip reader. The mean matched pair difference between measurement methods was analyzed by the paired t-test. The degree of correlation and agreement were evaluated by the Pearson's correlation coefficient and Bland–Altman plots, respectively. Results: The mean matched pair difference between the gold standard and all other pH measurement methods was the smallest with the portable electronic pH meter (bias 0.01, 95% confidence interval [CI] −0.07 to 0.08; p = 0.89), followed by strips read by a professional (bias −0.09, 95% CI −0.21 to 0.02; p = 0.10), layperson (bias −0.17, 95% CI −0.31 to −0.04; p = 0.015), and electronic strip reader (bias −0.29, 95% CI −0.41 to −0.16; p < 0.001). The portable electronic pH meter achieved the highest Pearson's correlation coefficient and narrowest 95% limits of agreement, followed by strip interpretation by a professional, electronic strip reader, and layperson. To quantify the ability of pH measurement methods to correctly classify values within a predefined urinary pH target range, we performed classification tests for several stones. The portable electronic pH meter outperformed all other measurement methods for negative predictive values. Conclusions: Findings of this study support that the portable electronic pH meter is a reliable pH measuring device. It appears to be more accurate compared to reagent strips readings.

Nephrolithiasis has become an increasing worldwide problem during the last decades. Metabolic syndrome, its components, and related dietary factors have been pointed out as responsible for the increasing incidence. The objective of this study was to evaluate the trends in the hospitalization rates of patients with nephrolithiasis, hospitalization features, costs, and how metabolic syndrome traits influence both the prevalence and complications of lithiasic patients. An observational retrospective study was conducted by analyzing hospitalization records from the minimum basic data set, including all patient hospitalizations in Spain in which nephrolithiasis has been coded as a main diagnosis or as a comorbidity during the period 2017–2020. A total of 106,407 patients were hospitalized and coded for kidney or ureteral lithiasis in this period. The mean age of the patients was 58.28 years (CI95%: 58.18–58.38); 56.8% were male, and the median length of stay was 5.23 days (CI95%: 5.06–5.39). In 56,884 (53.5%) patients, kidney or ureteral lithiasis were coded as the main diagnosis; the rest of the patients were coded mostly as direct complications of kidney or ureteral stones, such as “non-pecified renal colic”, “acute pyelonephritis”, or “tract urinary infection”. The hospitalization rate was 56.7 (CI95%: 56.3–57.01) patients per 100,000 inhabitants, showing neither a significant increasing nor decreasing trend, although it was influenced by the COVID-19 pandemic. The mortality rate was 1.6% (CI95%: 1.5–1.7), which was higher, if lithiasis was coded as a comorbidity (3.4% CI95%: 3.2–3.6). Metabolic syndrome diagnosis component codes increased the association with kidney lithiasis when age was higher, reaching the highest in the eighth decade of life. Age, diabetes, and hypertension or lithiasis coded as a comorbidity were the most common causes associated with the mortality of lithiasic patients. In Spain, the hospitalization rate of kidney lithiasis has remained stable during the period of study. The mortality rate in lithiasic patients is higher in elderly patients, being associated with urinary tract infections. Comorbidity conditions such as diabetes mellitus and hypertension are mortality predictors.

Background/Objective: The prevalence of kidney stones has increased, especially in industrialized countries. Obesity and metabolic syndrome have also risen significantly and are considered factors driving this trend. Our goal was to assess the hospitalization burden of kidney stones and identify epidemiological trends in Spain over the past 25 years. Additionally, this study analyzed the relationship between the data of kidney stone patients and obesity-coded diagnoses in hospital discharges. Methods: A retrospective observational study was conducted with the data from 1,070,192 patients hospitalized for urolithiasis between 1997 and 2021 using the Minimum Basic Data System. The hospitalization burden of lithiasis and its association with obesity was analyzed, alongside trend evaluations. The incidence of lithiasis in obese hospitalized patients versus all hospitalizations was compared. Mortality rates, length of stay, and the costs of lithiasis hospitalizations were evaluated to determine obesity’s impact on lithiasis patients. Results: Kidney stone cases increased by 1.8% annually (CI 95%: 0.2–3.3), with a more pronounced 10.7% (CI 95%: 7.3–14.2) increase in obesity-related hospitalizations. Obesity increased the likelihood of lithiasis hospitalization by 15.6 times and was associated with higher hospitalization costs. However, obesity did not significantly affect hospital stay duration or mortality rates. Conclusions: The increasing burden of kidney stone hospitalizations in Spain is linked to rising obesity rates. Obesity contributes to higher hospitalization costs. Preventive strategies targeting obesity should be implemented to reduce the burden on healthcare systems.

Background: Patients with kidney stones (KSFs) are known to have a heightened risk of coronary heart disease (CHD) or stroke. The objective of the present study was to describe the natural history of these complications through the longitudinal analysis of the hospitalizations due to kidney stones in Spain from 1997 to 2021. Methods: A retrospective longitudinal observational study was developed based on nationwide hospitalization data (minimum basic data base). Three different analyses were carried out. In the first step, the prevalence of coronary or cerebrovascular events in kidney stone hospitalizations was compared with the hospitalization burden of CHD or strokes related to the general population. In the second step, a survival analysis of the kidney stones–hospitalized patients using the Kaplan–Meier method was conducted. In the third step, a Cox regression was used to assess the influence of the classical comorbidities in the development of the lithiasic patients–cardiovascular disease. Results: Kidney stone-hospitalized patients exhibit a significantly higher risk of CHD (OR = 14.8 CI95%: 14.7–14.9) and stroke (OR = 6.7 CI95%: 6.6–6.8) compared to the general population across in all age groups, although they had less cardiovascular risk factors. A total of 9352 KSFs (1.5%) developed a coronary event within an average time of 78.8 months. A total of 2120 KSFs (0.33%) suffered a stroke in an average time of 71.1 months. Diabetes, hypertension, hyperlipidemia, and being overweight were identified as risk factors for developing CHD and stroke using a univariate and multivariate analysis. Conclusions: Our study confirms previous studies in which kidney stones must be considered as a risk factor for developing CHD or cerebrovascular disease. Preventive strategies should target patients with kidney stones and classical risk cardiovascular factors to mitigate modifiable conditions associated with cardiovascular diseases.