"With better education and research, our stone patients can decrease their disease risk and improve their overall health sooner rather than later," writes Stephen Y. Nakada, MD.
Endoscopic surgery, or “endourology,” currently represents a large part of all practicing urologists’ operative efforts. Moreover, urolithiasis remains the central disease process in these cases.
Contrary to common belief, the real question is not which scope to use, which laser is most efficient, or even whether to use ureteroscopy or shock wave lithotripsy. I believe the central focus for urologists should be stone prevention, nonsurgical disease management, and a better understanding of the lifestyle and treatment preferences of our stone patients.
Fortunately, Soueidan and associates address these concerns specifically. Beyond the traditional 24-hour urine collection, dietary tendencies, and fluid intake status, this study addresses smoking and low physical activity as substantive risk factors for recurrent urolithiasis. While this conclusion seems inherently obvious, suffice it to say these issues are rarely discussed in detail by most urologists and contemporary urologic studies are limited.
Of course, this and other studies have limitations related to small sample size, recall bias, and conflicting outcomes. But certainly the available data are compelling. Most of us have accepted the presence of a genetic component to urolithiasis, but at this point in time, genetic treatments remain conceptual. More notably, emphasis on available smoking cessation protocols and specific physical activity recommendations remain underutilized in many stone centers, including ours.
That said, where do we go from here? Certainly as a health care initiative, these changes are in line with general health benefits. I recommend further detailed, controlled studies, including multicenter trials. Both men’s health centers and women’s centers should educate patients on the detriments of smoking and physical inactivity, particularly among recurrent stone formers and those at risk for stones. With better education and research, our stone patients can decrease their disease risk and improve their overall health sooner rather than later.
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