Trends in Stone Disease

05 October 2017

Does warmer climate have influence on renal colic incidence? Why is understanding the patient experience particularly relevant to urolithiasis? Answers to these questions and other varied related topics were discussed in Plenary Session 02: Updates on Stone Disease on day one of the 4th Meeting of the EAU Section of Urolithiasis.

Call to boost research
“Urolithiasis is the most frequent urological disease and ranks number seven of all diseases. It is the most important urological disease but that is not reflected in our research,” said Prof. Peter Alken (DE) in his lecture “Trends in PNL” as he stated German hospital statistics in 2015 regarding the top 100 diseases in the country.

Alken pointed out that only 2.7% of all the registered urological studies were dedicated to urolithiasis. Based on the ClinicalTrials.gov of the U.S. National Institutes of Health, the number of registered urological studies between years 2000 and 2016 were on prostate cancer (3,752 studies), kidney cancer (3,387), bladder cancer (1,082), urinary tract infection (734) and urolithiasis (249).

“What should be the next In terms of research? Biopsies from the [renal] papilla,” Alken said. “We should also study about biomineralization.”

Rising numbers
In his lecture “Publication and Intervention Trends in Urolithiasis”, Prof. Bhaskar Somani (GB) said that “stone disease is rising and will continue to do so”, and that the “surgical paradigm for treatment is shifting.”

Somani cited results from the 2017 study “Trends in Upper Tract Stone Disease in England: Evidence from the Hospital Episodes Statistics Database” that between years 2016/2017 and 2013/2014, there was increase in feed conversion efficiency for urolithiasis (20%); ureteroscopy treatment for ureteric stones (67%) and kidney stones (133%); and percutaneous nephrolithotomy (149%)

He also discussed the results of a study on the worldwide impact of warmer seasons on the increase in incidence of renal colic and kidney stone disease. This study encapsulated findings of 13 studies (9 on renal colic and 4 on kidney stone disease) on more than two million people from 1990 to 2017.

More stone disease updates
Although the flight of Prof. Dr. Walter Ludwig Strohmaier (DE) was cancelled, he was still able to delliver his lecture “Impact of endoscopic findings on recurrence prevention and metabolics” via a live audio feed. Strohmaier stated that contrary to calcium oxalate urolithiasis, papillary calcifications uric acid urolithiasis is less important in the pathway of stone formation.

In his lecture “Residual fragments: Definition, management and follow-up”, Ass. Prof. Martin Schoenthaler (DE) called clinically insignificant residual fragment a “misnomer”. He added that complete stone clearance can only be confirmed by CT or possibly endoscopy, and that advanced ureteroscopy should aim at complete removal of fragments or creation of “micron-size debris”. Schoenthaler also stated that novel technologies for removal of fragments are possible solutions, and also mentioned robot-assisted technologies (micro- and nano-robots).

During his lecture “Patient’s expectations and quality of life in stone management”, Prof. Hammad Ather (PK) discussed how PROMIS pain measures are responsive to the phase of care during symptomatic stone events. He said that future studies in more diverse populations are needed to confirm the broad applicability of WISQOL (Wisconsin Stone Quality of Life questionnaire) and its clinical significance and utility. Ather also concluded that understanding the patient experience is particularly relevant to urolithiasis, which is considered a chronic disease with a tranquil baseline and unpredictable episodes of acute disruption with severe symptoms.

Concluding Plenary Session 02 and his lecture “Medical expulsive therapy: Valid concept or outdated treatment”, Prof. Dr. Christian Seitz (AT) raised the question “If the overall results of numerous randomized controlled trials (RCTs) show highly significant evidence of a treatment effect, but one large RCT indicates no benefit, is there good enough evidence this treatment should be denied to these patients?”