Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

Special Report

Virtual Tumor Board

Insights

Medcast

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

Clinical Forums Recaps

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Live Events

Interactive Tools

Job Board

Partners

Treatment Landscape Evolutions

Subscribe

Winoker is the director of endourology and director of the Center for Kidney Stone Disease at Lenox Hill and an assistant professor of urology at The Zucker School of Medicine at Hofstra/Northwell in New York, New York.

Videos

Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

Jared S. Winoker, MD, addresses the wide range of stone burdens treated by the CVAC system for the study.

Study results show CVAC 2.0 is safe, efficacious for wide range of kidney stones

Articles

The application is seeking an expanded indication of talazoparib plus enzalutamide for mCRPC.  

FDA Advisory Committee unanimously votes against talazoparib plus enzalutamide for mCRPC

The committee voted 4-5 in opposition of a favorable benefit-risk profile.

FDA Advisory Committee finds evidence for UGN-102 inconclusive, cites uncertainty in benefit-risk

Results from the phase 3 AMPLIFY trial are intended to support an application to the FDA for potential approval of 64Cu-SAR-bisPSMA. 

Pivotal trial launches of 64Cu-SAR-bisPSMA in BCR of prostate cancer 

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

LinkedIn

Spotlight

Peers and Perspectives

Clinical

1rem

Clinical Focus

Leonard G. Gomella, MD, FACS; Maha Hussain, MD, FACP, FASCO; Daniel P. Petrylak, MD

18th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

® Assistant Editor Janelle Hart spoke with 

 They discuss the association between kidney stones and climate change, and what the projections of their recent study evaluating this relationship will mean for future generations. Tasian is an associate professor of surgery and epidemiology at the University of Pennsylvania Perelman School of Medicine, a pediatric urologist at the Children’s Hospital of Philadelphia, and Director of Pediatric KIDney Stone (PKIDS) Care Improvement Network and Kaufman is a medical student at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania.

“The prevalence of kidney stones has increased over 80% over the last 30 years, and the epidemiology has changed such that it's beginning at a younger age now,” says Gregory Tasian, MD, MSc, MSCE.

Why kidney stones will become more prevalent over time

s® Managing Editor Ben Saylor spoke with 

 study, "Multi-institutional prospective randomized control trial of novel intracorporeal lithotripters: ShockPulse-SE vs Trilogy trial," for which she served as senior author. Krambeck is a professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

“You have tradeoffs with every device that you use,” says Amy E. Krambeck, MD.

Dr. Krambeck investigates efficacy of Trilogy and ShockPulse-SE lithotripters 

This episode’s guest is Amy E. Krambeck, MD. She discusses a recent Urology Practice paper, "Initial Experience With a Novel Single Use Disposable Ureteroscopy: A Prospective Single Arm 90-day Trial of the Axis Ureteroscope," for which she served as a study author. Krambeck is the Michael O. Koch Professor of Urology at Indiana University School of Medicine, Indianapolis.

Dr. Ranjith Ramasamy on nasal testosterone gel and sperm parameters

Dr. Amanda North on the gender pay gap in urology

Malpractice and stones: What a recent study reveals

On the latest episode of the Speaking of Urology podcast, Dr. Amy Krambeck discusses her recent study evaluating the Axis single-use ureteroscope.

Dr. Amy Krambeck discusses 90-day trial of disposable ureteroscope

This episode's guest is Peter L. Steinberg, MD. He discusses a recent 

 paper titled “Medical Malpractice and Nephrolithiasis: U.S. Appellate Cases From 2001- 2018,” for which he served as co-author. Steinberg is assistant professor of surgery at Harvard Medical School.

Dr. Finkelstein discusses telemedicine for pediatric post-op visits

What patients undergoing HIFU should expect postoperatively

Dr. Angela Smith discusses Jelmyto for low-grade UTUC


In this episode, Peter L. Steinberg, MD, discusses a recent Urology Practice paper that examined medical malpractice cases involving kidney stones.

Speaking of Urology - Malpractice and stones: What a recent study reveals

Professor Andreas Skolarikos shares his experience with the LithoVue Elite System.

Real-time IRP monitoring may redefine safety and scope of flexible ureteroscopy

Patient-reported pain scores were significantly improved with stent omission. 

Stent omission after ureteroscopy is safe, improves patient-reported outcomes 

“We do not feel that our results undermine the importance of fluid intake for stone prevention," says Alana C. Desai, MD. 

Intervention to increase fluid intake does not reduce recurrent stones

The investigators reported a median stone clearance of 96.44%.

CVAC 2.0 demonstrates efficacy for clearing stones less than 2 cm

New research links higher drinking water contaminants to increased kidney stone risk.

Drinking water contaminants could increase risk of kidney stones, study finds

A recent study presented at the American Urological Association 2025 Annual Meeting in Las Vegas, Nevada, detailed real-world outcomes with the CVAC 2.0 system for treating kidney stones.

“To provide some context, the emergence of suction- based technologies has really taken our field by storm. Among the most promising of these is the CVAC system for simultaneous endoscopic stone treatment and aspiration. With the goal of evaluating efficacy and safety of this device in a large, real-world cohort, we performed a retrospective review of all CVAC cases performed in our institution, beginning with the very first case, which was performed in February 2024, through February 2025. In total, we had more than 200 patients who ultimately underwent CVAC by 21 different surgeons. [A total of] 163 patients had complete pre- and post-op data, so those were the ones that were ultimately included in the analysis. Most notably, we found that the procedure was both very safe and highly effective for stone removal in a wide range of stone burdens, even amongst a variety of urologists with varying expertise,” said Winoker, director of endourology and director of the Center for Kidney Stone Disease at Lenox Hill and an assistant professor of urology at The Zucker School of Medicine at Hofstra/Northwell in New York, New York.

Jared S. Winoker, MD, discusses a recent study from the AUA annual meeting

In the interview, Winoker also addressed the wide range of stone burdens treated by the CVAC system for the study.  

“Not surprisingly, we observed the highest stone-fre. e rates in the smallest group, with really just a minimal decline in stone-free rate for larger stone burdens in that 20- to 29- mm group, before we really saw some more considerable drop-off in clearance of stone in the largest group, and that included many staghorn stones,” Winoker said.

“Interestingly, there was a noticeably lower CT-based stone-free rate in that 10- to 19-mm group, despite the much higher stone clearance in larger stones over 2 cm. I would say that this buck in the trend could really be explained by a number of factors. For one, post-op imaging of any kind was performed in only 70% of our patients, with a CT being the best measure of stone-free rate performed in just 20% of them. So there really is a large percentage of percentage of patients that were not accounted for here. Second, it's worth noting that many truly stone-free patients were likely purged from these data, as many surgeons elected not to obtain post-op imaging when they felt they had achieved a complete intraoperative stone clearance. Said differently, post-op imaging, notably CT scans, were generally reserved for those patients expected to have residual stone for the purposes of second stage treatment planning, for example, so that really biases the data toward some of the lower reported stone-free rates. That's a key distinction when we're interpreting these findings of a real-world practice compared to those of say, a more controlled study with standardized post-op imaging protocols,” Winoker said.

1. Klyde DM, Aro T, Okeke Z, Hoenig DM, Rai A, Winoker JS. Real-world experience with CVAC 2.0 for steerable ureteroscopic renal evacuation in a large, multi-site academic institution. 

. 2025;213(5S2). e36. doi:10.1097/01.JU.0001109712.09934.41.06

News

While the rate of ureteral strictures following ureteroscopic laser lithotripsy is low, the incidence was nearly doubled when using a thulium fiber laser (TFL) vs a holmium laser, according to data presented at the 

2025 American Urological Association (AUA) Annual Meeting

, offered an in-depth look into these findings and their implications. Patel is an endourology fellow at Northwestern University in Chicago, Illinois.

“TFL is a laser that's a little bit newer on the market compared to the holmium. It has some promising data with regards to surgical outcomes, but we did also note that many studies have noted increased working temperatures with the TFL use, but there has not been any strong studies looking at whether this had an impact on clinical outcomes,” Patel explained.

To that end, the investigators conducted a retrospective database analysis of 6726 patients who underwent ureteroscopic laser lithotripsy. Of those, 6178 had the procedure done with the holmium laser, and 548 had the procedure done with the TFL.

Data showed that the risk of stricture formation was 4.6% in the TFL cohort vs 2.4% in the holmium laser cohort. The adjusted relative risk of stricture formation within 120 days was 1.89 (95% CI, 1.22 to 2.8), per multivariate analysis.

Amir S. Patel, MD, offered an in-depth look into study findings on holmium vs TFL laser lithotripsy. 

Amir Patel, MD, on ureteral strictures following holmium vs TFL laser lithotripsy

Patel also touched on the implications of these findings for clinical practice.

“The implications of this are pretty significant. I think we do need to be aware of the fact that, whether it be due to the increased temperature or due to more aggressive laser settings used initially, with the advent of the TFL, we did find statistically significant higher rate of strictures with TFL compared to the holmium,” Patel noted.

He also added, “With regards to what can be done, there have been studies that show that ureteral access sheath use and pressurized irrigation are able to reduce the working temperatures in the kidney during laser lithotripsy.”

1. Patel A, Xu P, Roane A, Gibbs C, Mechlovich D, Stock L, Krambeck A. Ureteral stricture rates after holmium vs TFL ureteroscopic laser lithotripsy: A database analysis. 

. 2025; 213(5S):e38. doi:10.1097/01.JU.0001109712.09934.41.08

The risk of stricture formation was 4.6% in the TFL cohort vs 2.4% in the holmium laser cohort. 

Investigators recently conducted an anonymous survey to assess body and hand region discomfort when performing flexible ureteroscopy. Study author 

“This was a multi-institutional study, and the goal was to evaluate the urologist fatigue and discomfort in different body parts and different hand regions after performing flexible ureteroscopy. What we found was that, unfortunately, there was a significant increase in overall fatigue after performing flexible ureteroscopy, and also significant increase in discomfort in different body and hand regions. And what we found was that unfortunately, women were significantly more affected,” said Razavi, assistant professor of urology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Investigators recently conducted an anonymous survey to assess body and hand region discomfort when performing flexible ureteroscopy. Study author Sarah Razavi, MD, discussed the findings with Urology Times

Sarah Razavi, MD, discusses the physical toll of ureteroscopy on urologists

During the interview, Razavi was asked, given the significant increase in overall fatigue post-ureteroscopy, particularly among female surgeons, to elaborate on potential ergonomic or procedural factors that might contribute to this disparity. She said, “I think one of the most important hypotheses we had was the size mismatch, because we know that women have smaller hand size compared to men, and what we found in this study is that urologists with larger glove size have lower discomfort. I think 1 important hypothesis is that the currently available ureteroscopes are not designed for urologists with small hands, and that will put women at a disadvantage, especially because you have to use the scope repeatedly. You have to use your muscles repetitively, and if the scopes are not designed for your small hands, you have to sometimes exert more force into your different hand muscles, and that might be the reason for increased discomfort in women.”

She added, “One other hypothesis is that we know women have lower body mass compared to men, and performing ureteroscopy requires the urologist to be in a static position, sometimes for a long period of time, and so women with lower body strength might be at a disadvantage.”

1. Razavi S, Udedeibia E, Chrouser KL, et al. Urologist's fatigue and discomfort in different body regions after performing flexible ureteroscopy. 

. 2025 Apr 4:S0090-4295(25)00314-0. doi:10.1016/j.urology.2025.04.004

"There was a significant increase in overall fatigue after performing flexible ureteroscopy," says Sarah Razavi, MD.

Combination treatment with phentermine and topiramate may offer an option for uric acid stone prevention, according to data from the POuND OUT study (NCT04621929), which were presented at the 

2025 American Urological Association Annual Meeting

, detailed key findings from the feasibility study.

In total, the study randomly assigned 19 patients in a 2:1 fashion to either combination phentermine/topiramate or to standard therapy. The median age of patients was 62 years.

Data showed that patients in the combination treatment arm demonstrated fewer stone procedures, lower HbA1c levels, and higher urine pH compared with those in the control arm.

Specifically, the increase in urine pH (from the end of study minus baseline) was +0.9 (±0.4) in the treatment arm vs +0.2 (±0.3) in the control arm. Further, HbA1c levels decreased by -0.6 (±0.9) in the treatment arm and increased by +0.4 (±0.8) in the control arm.

Joshua Heiman, MD, detailed key findings from the POuND OUT feasibility study of phentermine and topiramate for uric acid stone prevention. 

Joshua Heiman, MD, on phentermine plus topiramate for uric acid stone prevention

Heiman also added, “Patients who were on this medication, their stone volume decreased by greater than 50% when compared to the control group. It's pretty impressive, very remarkable, to see this drastic change in their stone volume while taking this medication.”

The treatment also appeared to be well-tolerated.

While promising, these data were only part of a feasibility study evaluating the combination. Further work is needed to assess this regimen in a wider range of patients with obesity and diabetes, according to the authors.

1. Heiman JM, Canales MT, Terry RS, et al. The POuND OUT study: Phentermine and topiramate for uric acid stone prevention. 

. 2025;213(5S):e1155. doi:10.1097/01.JU.0001110128.62940.65.01

Joshua M. Heiman, MD, details key findings from the POuND OUT study.  



A recent study evaluated silicone vs polyurethane stents found that the primary outcome of pain intensity and interference at 7 to 10 days did not show a significant difference between the silicone and polyurethane stent groups.

, John Michael DiBianco, MD, discussed what he found clinically relevant from the study, which was presented at the 40th Annual European Association of Urology Congress in Madrid, Spain.

John Michael DiBianco, MD, discussed what he found clinically relevant from the study

Investigators evaluate patient outcomes with silicone vs polyurethane stents

“Unfortunately, stenting is a kind of necessary and known evil of ureteroscopy and stone treatment. The fact is that, especially in the United States, we are very far away from a time period where stents will not be necessary or commonly utilized. If we are doing, let's say, 100,000 of these cases every year, a million of these cases every year, can we make some sort of percentage difference, whether it's 2%, 4%, 5%. With numbers like that, that can make a lot of a difference to a lot of patients. I think that most urologists out there who do stone treatment and who stent people are biased in a way that we hear the stories, we hear the patient calls when patients are not happy with their stents and so forth. At least in my experience, I think that with some of the newer silicone stents, the ImaJin Hydro and other silicone stents, we tend to potentially hear less of that. That kind of biases me. Although maybe certain scoring surveys are not sensitive enough to pick up what a lot of us feel anecdotally in a clinical trial such as this, or the real nuts and bolts science, I think that a clinically relevant outcome is potentially less phone calls, maybe those daily pain scores, which may be a little bit more accurate as far as how the patient's feeling at that moment, rather than surveys, reflectively looking back,” said DiBianco, an assistant professor of urology at the University of Florida in Gainesville.

1. DiBianco JM, Daignault-Newton S, Shoemaker E, et al. Is there a better stent? The Better Lithotripsy and Ureteroscopy Evaluation of Stenting (BLUES) randomized clinical trial comparing the patient experience of silicone vs polyurethane stents. Presented at: 40th Annual European Association of Urology Congress. March 21-24, 2025. Madrid, Spain. Abstract LB2. https://urosource.uroweb.org/resource-centres/EAU25/263407/abstract

John Michael DiBianco, MD, discusses findings from the BLUES trial.

A study presented at the 40th Annual European Association of Urology Congress in Madrid, Spain, compared outcomes with silicone vs polyurethane stents.

, John Michael DiBianco, MD, discussed the background for the study.

“BLUES, or Better Lithotripsy and Ureteroscopy Evaluation of Stenting, is an investigator-initiated clinical trial sponsored by Coloplast. [It] is essentially a comparative effectiveness randomized clinical multi center in the state of Michigan, [with the] MUSIC, or Michigan Urological Surgical Improvement Collaborative-partnered hospitals evaluating quality of life and health care utilization after stenting and ureteroscopy in the treatment of stone disease with either a polyurethane standard of care ureteral stent vs the silicone ImaJin Hydro,” said DiBianco, assistant professor of urology at the University of Florida in Gainesville.

John Michael DiBianco, MD, discusses a study presented at EAU 2025

John Michael DiBianco, MD, on silicone vs polyurethane stents for patients with kidney stones

“What we ended up finding was that the 2 main pain-related outcomes were actually not statistically different between the ImaJin Hydro and the polyurethane patients’ daily pain scores, its impact on work afterwards, during the first 7 days after their procedure, as well as how many phone calls and EHR messages patients sent to the offices and the urologists was trending toward significance in favor of the ImaJin Hydro silicon stent, although it didn't reach statistical significance. But trouble doing work—whether patients could continue their usual work—treatment satisfaction, [or] how satisfied patients were with their treatment experience, and as well as if patients felt negatively about the possibility of receiving a stent in the future, those were statistically significantly in favor of the ImaJin Hydro so in general, overall, with the results [there was] no humongous difference negatively as far as the silicon stent, but many of the different aspects were in the positive direction for the silicon stent, as well as several being statistically significantly better,” DiBianco added.

DiBianco discusses findings from the Better Lithotripsy and Ureteroscopy Evaluation of Stenting trial.

, presented a talk titled, “State-of-the-Art Lecture: Update on the SOUL Trial: To Stent or Not to Stent.” In an interview with 

®, Ghani recaps this session, touching on the background, design, and current update on the trial.

Overall, the SOUL study (NCT05866081) is assessing patient-reported outcomes and unplanned health care utilization among patients who had stent placement vs patients who had stent omission following ureteroscopy for stones.

Ghani explained, “We hypothesized that patients who are stented have significantly more pain and they consume more health care utilization than folks who are not stented. There is good evidence in the literature to say that not to place a stent is safe, but there is a lack of large multi-center evidence around this. As a result of that, this study got funded by the Patient Centered Outcomes Research Institute to better assess this and provide high-quality evidence.”

Ghani is a clinical professor of urology and the program director of the Michigan Urological Surgery Improvement Collaborative (MUSIC) at the University of Michigan in Ann Arbor.

Khurshid R. Ghani, MBChB, MS, FRCS, recaps a talk titled, “State-of-the-Art Lecture: Update on the SOUL Trial: To Stent or Not to Stent.”

Khurshid Ghani, MD, on trial of stent omission following ureteroscopy

The SOUL trial is designed to include both a randomized cohort and an observational-only cohort.

In total, the study plans to enroll approximately 800 patients across 16 trial centers in the US, with 550 enrolled to date. Patients in the study need to be planned for unilateral ureteroscopy and lithotripsy for stone disease and their largest stone must be 10 mm or smaller in size.

“I think we're at an inflection point technologically in stone disease, where the scopes are getting really small [and] the lasers are getting really good,” Ghani concluded. “I hope we're at that point in the curve where now surgeons do feel comfortable that they can do stent omission. Our goal is to unpack that evidence. I hope I can be here, back at the AUA, or my team, in 1 or 2 years, presenting the clinical results.”


1. Stent Omission After Ureteroscopy and Lithotripsy in the Michigan Urological Surgery Improvement Collaborative. ClinicalTrials.gov. Last updated May 30, 2024. Accessed May 2, 2025. https://clinicaltrials.gov/study/NCT05866081

The SOUL study is assessing patient-reported outcomes and unplanned health care utilization among patients who had stent placement vs stent omission after ureteroscopy.

®, endourologist Perry Xu, MD, was asked about how he goes about shared decision-making in his practice.

“Coupled with all of these innovations, there are also all these discussions that you must have with the patients so that they best understand all the risks and all the benefits attached to each one. It really does depend on their current disease state. For example, having a conversation with someone who's acutely in pain, who's having a lot of nausea and vomiting and they have an obstructing stone, that's going to be an entirely different conversation than a conversation with someone who has a non-obstructing stone [and] was sent to you by their primary care doctor just because they have a stone there. It's not been bothered bothering them; they've known about it for years, but now they suddenly want to do something about it,” said Xu, an assistant professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Kidney Stones

Latest News