Mayo Clinic

Karen L. Stern, MD, reviews Next Generation Sequencing (NGS) concerns, places for NGS in urology, and benefits of standard urine cultures. Dr. Stern analyzes a 2017 study of 44 patients, explaining that NGS can lead to overtreatment. Using statistics from the CDC, she also illustrates the potential for NGS to contribute to antibiotic resistance.

Dr. Stern notes that NGS is generally expensive since it is labor intensive, and the technology may not be cost-effective in high-risk patients. She also reviews the potential for increased false positives with NGS, comparing the sensitivity and specificity rates of NGS and standard urine cultures. She highlights the lack of research on NGS and calls for additional analysis into its capabilities.

However, Dr. Stern reviews data from the World Congress and concedes that NGS may have some specific uses in urology. Dr. Stern continues by comparing stone cultures and renal pelvis urine cultures to preoperative midstream urine cultures, highlighting the utility of these cultures while acknowledging the lack of research comparing them to NGS.

She transitions to a 2018 study and evaluates the listed NGS successes, expressing doubts about the usefulness and nature of these successes. Dr. Stern completes her discussion by emphasizing the need to research NGS further and reserve NGS for specific areas in urology, urging urologists to turn to standard cultures for detection.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Next Generation Sequencing vs. Standard Culture–NGS.”

Karen L. Stern, MD, discusses the benefits of 24-Hour urine tests over Empiric Therapy alone in the diagnosis and treatment of kidney stones. Dr. Stern cites American Urological Association (AUA) guidelines urging “additional metabolic testing in high-risk or interested first-time stone formers and recurrent stone formers.” Dr. Stern explains that metabolic urine testing, such as the 24-Hour test, is effective in screening for other relevant health issues, in addition to providing treatment guidance.

She cites data that show that kidney stones lead to renal dysfunction, and emphasizes that kidney stones often need more than dietary recommendations to treat. Medical therapy can help reduce stone recurrence.

Dr. Stern points out that 24-hour urine tests track patient compliance. She then discusses adverse effects of medication and asserts that 24-hour urine testing helps focus the therapy to the patient’s individual needs rather than taking a one-size-fits-all approach. Dr. Stern summarizes her points that 24-hour urine testing for kidney stones is guideline-supported, provides a workup of a chronic disease, provides effective screening, tracks compliance, and avoids unnecessary side effects and costs for patients.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: 24-Hour Urines vs. Empiric Therapy–Empiric Therapy.”