Endourologist discusses shared decision-making and laser lithotripsy

In a recent interview with Urology Times®, 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.

He added, “All the treatment options we have available have their different complications. They have their different recovery periods. Shared decision-making is a huge part of my practice. We need to understand what the patient's goals are and what they want out of their treatment option. For kidney stone disease, I offer shock wave [lithotripsy], I offer ureteroscopic treatment, I offer PCNL. I also just offer observation. I always take an overall look at their medical health, whether they're suitable candidates for certain surgeries, and I do tell them their options based on that assessment. I always make sure my patients are very keenly understanding [of] the recovery period as well as the risks that they sign up for [with] their surgeries.

In the interview, Xu was also asked for his opinion on the current state of laser lithotripsy.

“Laser technology is extremely exciting in endourology. Most of the time, we use holmium lasers, but there's been advancements in thulium fiber lasers. There's been advancements in thulium:YAG lasers. Within the lasers themselves, we're learning more about pulse modulation, about the effects of peak power, about our laser settings,” Xu said.