Alternatives to opioid use, obstructed pyelonephritis, and residual fragments following ureteroscopy are among the topics of note in stone disease at this year’s meeting, says Brian R. Matlaga, MD, MPH, professor of urology at Johns Hopkins University School of Medicine, Baltimore. Here is what he had to say ahead of the meeting.
“Any urologist who places ureteral stents know that they can be painful for our patients, and oftentimes require the administration of narcotic agents to provide effective pain control. In recent years, though, our field has come to recognize that there may be an over-reliance on these narcotic agents, and furthermore that there are a host of deleterious consequences that may occur in the setting of narcotic utilization. Dr. Ryan Hsi’s group from Vanderbilt University will report on the persistent use of opioid agents following ureteroscopy, an area of particular concern (MP68-02).
“Dr. Kevan Sternberg’s group from the University of Vermont will describe an important study that they undertook that illustrates methodologies that permit an opioid-free approach to post-ureteroscopy pain management (PD53-07).
“In another effort to explore alternatives to opioid agents, Dr. Stephen Nakada’s group at the University of Wisconsin will report the findings of their randomized controlled trial evaluating the effectiveness of pre-treatment with tolterodine (Detrol) in an effort to control ureteral stent symptoms (PD35-06).
“In an effort to better understand emergency department utilization following ureteroscopy, the group from University of Michigan, led by Dr. John Hollingsworth, leveraged the exceedingly robust network of the Michigan Urological Surgery Improvement Collaborative (MUSIC) (PD53-01). This large-scale effort will allow the identification of care pathways, perhaps some of which leverage the aforementioned regimens, in an effort to optimize the patient experience.
“Other abstracts are focused on optimizing care pathways for patients with acute stone events. Obstructive pyelonephritis is a urologic emergency, with a known mortality associated with it. Dr. Ojas Shah’s group from Columbia University developed a protocol that reduces the variation in how such patients are managed in the acute setting (MP89-07).
“Dr. Peggy Pearle’s group at the University of Texas Southwestern Medical Center have previously reported on the rigorous CT-based detection of residual fragments following URS. At this meeting, they will be presenting on the fate of these residual fragments—an important concern for patient and physician alike (PD45-02).
“When it comes to percutaneous nephrolithotomy, some of the most experienced surgeons hail from China. Dr. Guohua Zeng’s group from Guangzhou will be reporting a multicenter, randomized controlled trial comparing super mini-PCNL to ureteroscopic stone treatment (PD 35-01).