Preface

It is a distinct pleasure to serve as an editor for this book dedicated to nephrolithiasis, laser fragmentation, and a novel use of a well-known surgical technology.

Nephrolithiasis or nephrocalcinosis (the formation of kidney stones or renal calculi) is a common problem worldwide with substantial consequences in terms of morbidities and economic burden. The incidence of kidney stones has increased in recent decades along with a significant narrowing of the gender gap. Similarly, the incidence of kidney stone formation in the pediatric population is on a gradual incline.

In this text, we present a host of international scientists/authors who have composed and contributed updates and some advances to the existing body of literature as it relates to the pathophysiology of stone formation; laser pulse–induced calculus damage; the increased in‐ cidence and recurrence of kidney stones in the pediatric population; a comprehensive re‐ view of inheritance patterns; diagnosis, medical treatment, and prevention of cystinuria; and finally recent trends in the novel utility of extracorporeal shock wave lithotripsy, as com‐ monly used modality of treatment for kidney stones.

The first chapter of Section 1 is dedicated to discussing our current understanding of the pathophysiology of nephrocalcinosis. In a comprehensive manner, the authors explore and review the genetics of predisposing conditions to nephrocalcinosis. This chapter explores and compares the mechanisms that propagate renal and vascular calcifications, including tubular calcinosis and interstitial calcinoses. Furthermore, it touches on the molecular fac‐ tors that contribute to cell-driven calcification such as phosphates, oxidative stress, hor‐ mones, and microRNAs.

In the subsequent chapter, the authors underscore the high rate of recurrent kidney stones in the pediatric population and the importance of metaphylaxis, including how a thorough as‐ sessment and planning are essential to provide accurate and effective therapy. When consid‐ ering dietary modifications, a risk and benefit assessment is particularly important in this population since their development is an ongoing process. If dietary modification is not suf‐ ficient, medical treatment must be implemented.

The final chapter of Section 1 provides a very detailed review of the rare genetic condition of cystinuria. At present, preventative medical treatment is the mainstay of treatment aimed at reducing the calculi burden to avoid the risk of chronic renal impairment. Our evolving under‐ standing of the genetic mutations implicated in this will eventually foster targeted treatments.

In a section devoted to modalities of treatment, we include a chapter on the physics of laser fragmentation of calculi. While laser lithotripsy is now a preferred treatment option for uro‐ lithiasis, the mechanism of laser pulse–induced calculus damage is still not fully under‐ stood. They use a combination of a high-speed camera with hydrophone, pendulum, and Schlieren imaging methods to characterize cavitation bubble, shock wave, and fiber burn‐ back and retropulsion. This is particularly important as replacement of damaged fibers and retreatment rates accrue a significant healthcare expense.

The final chapter covers novel uses of extracorporeal shockwave lithotripsy (ESWL). Since its introduction in the 1980s, ESWL has been offered as a minimally invasive method of treating renal calculi. In recent years, ESWL has been used successfully in the management of various other anatomical sites.

In recent decades, we have enhanced our understanding of the pathophysiology and genet‐ ics of rare and common causes of kidney stones. With our evolving understanding of the epidemiology, biology, and genetics of nephrolithiasis and the advances in therapeutic tech‐ nologies, we have made significant progress in patient care. Furthermore, advances in the medical management and surgical technologies have allowed us to embellish the optimal outcomes in the management of complex kidney stone disease.

This body of work, and the ongoing investigations to follow, will continue to strengthen our understanding of nephrolithiasis and help us to get closer to developing sophisticated tool to offer even more definitive treatment options for patients.

> **Dr. Layron Long** Samaritan Urology Chief of Robotic Section Director of Urological Robotic Surgery Fellowship trained in Robotic, Laparoscopy and Endourology Good Samaritan Regional Medical Center Corvallis, OR, USA

**Pathophysiology of Nephrolithiasis**

stood. They use a combination of a high-speed camera with hydrophone, pendulum, and Schlieren imaging methods to characterize cavitation bubble, shock wave, and fiber burn‐ back and retropulsion. This is particularly important as replacement of damaged fibers and

The final chapter covers novel uses of extracorporeal shockwave lithotripsy (ESWL). Since its introduction in the 1980s, ESWL has been offered as a minimally invasive method of treating renal calculi. In recent years, ESWL has been used successfully in the management

In recent decades, we have enhanced our understanding of the pathophysiology and genet‐ ics of rare and common causes of kidney stones. With our evolving understanding of the epidemiology, biology, and genetics of nephrolithiasis and the advances in therapeutic tech‐ nologies, we have made significant progress in patient care. Furthermore, advances in the medical management and surgical technologies have allowed us to embellish the optimal

This body of work, and the ongoing investigations to follow, will continue to strengthen our understanding of nephrolithiasis and help us to get closer to developing sophisticated tool

> **Dr. Layron Long** Samaritan Urology Chief of Robotic Section

> > Corvallis, OR, USA

Director of Urological Robotic Surgery

Good Samaritan Regional Medical Center

Fellowship trained in Robotic, Laparoscopy and Endourology

retreatment rates accrue a significant healthcare expense.

outcomes in the management of complex kidney stone disease.

to offer even more definitive treatment options for patients.

of various other anatomical sites.

VIII Preface
