Dr. De on the biggest unmet needs in kidney stone treatment


"I think there have been a lot of what I would consider incremental improvements over the past few years," Smita De, MD, PhD.

In this video, Smita De, MD, PhD, discusses the biggest unmet needs in kidney stone treatment. De is a staff physician at the Glickman Urological & Kidney Institute at Cleveland Clinic, Cleveland, Ohio and a clinical assistant professor of urology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.


What are the biggest unmet needs in kidney stones at the moment?

I think there have been a lot of what I would consider incremental improvements over the past few years. We just talked about one, which is the miniaturization of a lot of our instrumentation. There is, of course, the thulium fiber laser, that is now being used a lot. But overall, we're still treating stones mostly the same way: there is either shock wave lithotripsy, or they stick a scope in the kidney somehow or other and laser the stones, or use some sort of ultrasonic device. I think there are a lot of really exciting stuff coming up. These techniques, while they've been improving over time with these new innovations, the stone-free rates are actually not that great. Not too long ago, the Journal of Endourology basically said that they were only going to be looking for papers and trials that discussed stone-free rates that use CT scans to look at stone-free rates, as opposed to ultrasound and X ray or KUB, which have been used for many of the prior trials that established stone-free rates. So as we're doing these CT scans to look at stone-free rates, I think we're finding that we're really not as good as we thought we were or hoped we were. I think this provides a lot of opportunity. There are just completely new ways of treating stones instead of sticking in a scope somewhere and using a laser or the shock wave lithotripsy. And I think there are some really neat things coming out. You have burst wave lithotripsy out of the University of Washington, and then we're also doing some work using nanotechnology for trying to treat stones. We are, of course, at the very early, petri-dish stages here. But these techniques are really unlike a lot of what we've been doing for decades, so I'm hoping that they provide an opportunity either for better stone-free rates or for being able to treat patients who may have not had a lot of options due to their anatomy or other medical condition.

This transcription was edited for clarity.

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