UROLITHIASIS/ENDOUROLOGY
2009
Editorial Comment: The European Association of Urology guidelines are somewhat different than the document generated by the American Urological Association and the American Society of Nephrology. The EAU recommends that a metabolic evaluation be undertaken when a patient is stone-free. In many instances this approach is not possible or practical. The EAU also has different algorithms for calcium oxalate and calcium phosphate stones. In addition, the EAU endorses the use of sodium bicarbonate to treat patients with calcium oxalate stones and increased calcium excretion. This approach may have a negative effect in that it could augment calcium excretion due to the sodium load. There are other recommendations based on low level evidence. Nevertheless, the document is well written and contains a lot of useful information. Thus, it is worth reading. Dean G. Assimos, MD
Suggested Reading Pearle MS, Goldfarb DS, Assimos DG et al: Medical management of kidney stones: AUA guideline. J Urol 2014; 192: 316. Sakhaee K, Harvey JA, Padalino PK et al: The potential role of salt abuse on the risk for kidney stone formation. J Urol 1993; 150: 310.
Re: The ROKS Nomogram for Predicting a Second Symptomatic Stone Episode A. D. Rule, J. C. Lieske, X. Li, L. J. Melton, III, A. E. Krambeck and E. J. Bergstralh Division of Nephrology and Hypertension, Department of Medicine, Divisions of Epidemiology, and Biomedical Statistics and Informatics, Department of Health Sciences Research, Department of Laboratory Medicine and Pathology, and Department of Urology, Mayo Clinic, Rochester, Minnesota J Am Soc Nephrol 2014; 25: 2878e2886.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.035 available at http://jurology.com/ Editorial Comment: This may be the first nomogram synthesized to predict a recurrent symptomatic kidney stone event. This tool may be helpful in selecting individuals for preventive pharmacotherapy and fostering shared decision making between the patient and physician. The nomogram is designed for patients with more mundane stone composition and not applicable for patients with brushite, cystine or infection stones. The tool warrants validation in a prospective trial. Dean G. Assimos, MD
Suggested Reading Trinchieri A, Ostini F, Nespoli R et al: A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol 1999; 162: 27.
Re: Quantification of Asymptomatic Kidney Stone Burden by Computed Tomography for Predicting Future Symptomatic Stone Events M. G. Selby, T. J. Vrtiska, A. E. Krambeck, C. H. McCollough, H. E. Elsherbiny, E. J. Bergstralh, J. C. Lieske and A. D. Rule Divisions of Nephrology and Hypertension, Biomedical Statistics and Informatics, and Epidemiology, and Departments of Diagnostic Radiology and Urology, Mayo Clinic, Rochester, Minnesota Urology 2015; 85: 45e50.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.036 available at http://jurology.com/ Editorial Comment: Patients harboring asymptomatic renal stones are usually interested in knowing the future risk of a painful event or surgical stone removing procedure. These investigators found that stone volume was the only computerized tomographic predictor on multivariate analysis. They also demonstrated that rapid stone growth is associated with such occurrences. This finding will need to be confirmed in a nontertiary patient cohort. I predict that getting a radiologist to measure
2010
UROLITHIASIS/ENDOUROLOGY
stone volume may be a hurdle. This issue can be overcome with software that is user friendly, allowing the clinician to quantify stone volume firsthand. Such information may be helpful when counseling patients with asymptomatic kidney stones. Dean G. Assimos, MD
Suggested Reading Kang HW, Lee SK, Kim WT et al: Natural history of asymptomatic renal stones and prediction of stone related events. J Urol 2013; 189: 1740.
2009
Editorial Comment: The European Association of Urology guidelines are somewhat different than the document generated by the American Urological Association and the American Society of Nephrology. The EAU recommends that a metabolic evaluation be undertaken when a patient is stone-free. In many instances this approach is not possible or practical. The EAU also has different algorithms for calcium oxalate and calcium phosphate stones. In addition, the EAU endorses the use of sodium bicarbonate to treat patients with calcium oxalate stones and increased calcium excretion. This approach may have a negative effect in that it could augment calcium excretion due to the sodium load. There are other recommendations based on low level evidence. Nevertheless, the document is well written and contains a lot of useful information. Thus, it is worth reading. Dean G. Assimos, MD
Suggested Reading Pearle MS, Goldfarb DS, Assimos DG et al: Medical management of kidney stones: AUA guideline. J Urol 2014; 192: 316. Sakhaee K, Harvey JA, Padalino PK et al: The potential role of salt abuse on the risk for kidney stone formation. J Urol 1993; 150: 310.
Re: The ROKS Nomogram for Predicting a Second Symptomatic Stone Episode A. D. Rule, J. C. Lieske, X. Li, L. J. Melton, III, A. E. Krambeck and E. J. Bergstralh Division of Nephrology and Hypertension, Department of Medicine, Divisions of Epidemiology, and Biomedical Statistics and Informatics, Department of Health Sciences Research, Department of Laboratory Medicine and Pathology, and Department of Urology, Mayo Clinic, Rochester, Minnesota J Am Soc Nephrol 2014; 25: 2878e2886.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.035 available at http://jurology.com/ Editorial Comment: This may be the first nomogram synthesized to predict a recurrent symptomatic kidney stone event. This tool may be helpful in selecting individuals for preventive pharmacotherapy and fostering shared decision making between the patient and physician. The nomogram is designed for patients with more mundane stone composition and not applicable for patients with brushite, cystine or infection stones. The tool warrants validation in a prospective trial. Dean G. Assimos, MD
Suggested Reading Trinchieri A, Ostini F, Nespoli R et al: A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol 1999; 162: 27.
Re: Quantification of Asymptomatic Kidney Stone Burden by Computed Tomography for Predicting Future Symptomatic Stone Events M. G. Selby, T. J. Vrtiska, A. E. Krambeck, C. H. McCollough, H. E. Elsherbiny, E. J. Bergstralh, J. C. Lieske and A. D. Rule Divisions of Nephrology and Hypertension, Biomedical Statistics and Informatics, and Epidemiology, and Departments of Diagnostic Radiology and Urology, Mayo Clinic, Rochester, Minnesota Urology 2015; 85: 45e50.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.036 available at http://jurology.com/ Editorial Comment: Patients harboring asymptomatic renal stones are usually interested in knowing the future risk of a painful event or surgical stone removing procedure. These investigators found that stone volume was the only computerized tomographic predictor on multivariate analysis. They also demonstrated that rapid stone growth is associated with such occurrences. This finding will need to be confirmed in a nontertiary patient cohort. I predict that getting a radiologist to measure
2010
UROLITHIASIS/ENDOUROLOGY
stone volume may be a hurdle. This issue can be overcome with software that is user friendly, allowing the clinician to quantify stone volume firsthand. Such information may be helpful when counseling patients with asymptomatic kidney stones. Dean G. Assimos, MD
Suggested Reading Kang HW, Lee SK, Kim WT et al: Natural history of asymptomatic renal stones and prediction of stone related events. J Urol 2013; 189: 1740.
