Kidney Stones

As the year comes to a close, we revisit some of this year’s top content on urologic stones.

Thomas Chi, MD, discusses 2022 milestones in stone disease and looks ahead to what might be on the horizon for the field in the coming year.

"These technologies have the potential to provide an advantageous and patient-centered solution for the gap between expectant management and urologic intervention for symptomatic ureteral stones,” says M. Kennedy Hall, MD, MHS.

The team of investigators used the COST-FACIT tool to take into account both the time and money lost to treatment.

"Knowing the dietary factors that are most important for preventing kidney stone recurrence can help patients and providers know what to prioritize,” said Andrew Rule, MD.

"As more genes are classified and catalogued, diagnosis and treatment of kidney stones inches further and further toward 'precision medicine,' " write Rutul Patel, DO, MS, and Alexander Small, MD.

"We need to try to do as much as we can to limit sepsis, and basing it on the patient's preoperative risk factors can be very helpful," says Naeem Bhojani, MD, FRCSC.

“The take-home message is that there is a new form of lithotripsy,” says Jonathan D. Harper, MD.

“We saw that this appears to be a safe treatment with very little bleeding,” says Jonathan D. Harper, MD.

In this installment of Urology Times' 50th Anniversary Innovation Celebration, James E. Lingeman, MD, discusses the development of extracorporeal shock wave lithotripsy for the treatment of kidney stones.

"The seminal innovation was the idea that you could create a focused shock wave that could be delivered into the body in a non-invasive way that had sufficient energy to break up a stone but not damage other structures," says James E. Lingeman, MD.

“One thing from our study that you can take home [is] no matter what the surgery is, small changes right after surgery can actually tell you more than we usually give them credit for,” says Sevag Demirjian, MD.

“The take home message would be that in patients with prior history of kidney stone episodes…receiving 24-hour urine testing prior to starting pharmacologic preventive therapy is associated with a lower probability of a subsequent stone-related event,” says Ryan Hsi, MD, FACS.

In this interview, Caleb Nelson, MD, PhD, discusses the current state of evaluation and treatment of stones in pediatric patients.

Gregory Tasian, MD, MSc, MSCE, and Jason Kaufman co-authored a study that investigated the association between kidney stone presentations in South Carolina under 2 different climate change scenarios.

The designation was awarded to the Acoustic Enhancer, a micro bubble composed of a gas core with a lipid shell, which is intended for use in conjunction with standard laser lithotripsy.

“I think there is an urgency for us as urologists who are seeing many of these patients with kidney stones to be advocates, not just for the patients whom we're treating today, but for the populations in the future,” says Gregory Tasian, MD, MSc, MSCE.

"The devices, telemedicine and remote care, and outpatient surgery risk us losing the human connection we had with the patient, as time spent with them is at a premium today," writes Gopal H. Badlani, MD.

“The main question we were interested in answering was what the impact of future climate under different scenarios of climate change would have on the incidence of kidney stone disease, using South Carolina as a model state,” says Jason Kaufman.

"Our analysis suggests that a warming planet will likely cause an increased burden of kidney stone disease on health care systems,” says Gregory E. Tasian, MD, MSc, MSCE.

Investigators evaluated data from the Continuous National Health and Nutrition Examination Survey.

“Going into this study, we thought that potentially patients who had a stent placed with the string left in place were at higher risk of having a complication…But we found that they weren't at higher risk of a complication,” says Amy E. Krambeck, MD.

In a cohort of nearly 30,000 patients, more than half had cystoscopy-based stent removal within 6 months post ureteroscopy, investigators reported.

“I currently make regular use of a peripheral nerve block during PCNL…with the intent of, of limiting my patients exposure to and the need for opioids,” says Jared S. Winoker, MD.

“[Kidney stones] really seems like something that we should be devoting significant resources and effort to trying to figure out the root causes and also better treatments and therapies for,” says Jonathan E. Shoag, MD.

“We should really try to adapt, know what we're doing to the specific patient based on their risk factors, prepare them appropriately, and understand that it's a dangerous complication. We should do everything we can to prevent it,” says Naeem Bhojani, MD, FRCSC.

“The most notable finding unquestionably was that peripheral nerve blocks have the ability to significantly reduce opioid requirements without compromising any pain control,” says Jared S. Winoker, MD.

In 2 recent studies led by Naeem Bhojani, MD, FRCSC, and Ben H. Chew, MD, MSc, investigators performed a meta-analysis to identify predictors of sepsis as well as the cost of sepsis for patients with stone disease.

“Ideally…we have a technology that's noninvasive that we can use in the clinic, where they don't require any anesthesia to…break the stones and make them smaller,” says Mathew D. Sorensen, MD, MS, FACS.

"Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service," writes Jonathan Rubenstein, MD, and Mark Painter.