Karen L. Stern, MD, Author at Grand Rounds in Urology

Karen L. Stern, MD

Mayo Clinic

Phoenix, AZ

Disclosures:

Karen L. Stern MD is an Associate Professor in the Department of Urology at the Mayo Clinic Arizona in Phoenix, Arizona. Dr. Stern received her MD from the University of Arizona, where she received the Alpha Omega Alpha distinction. She completed Urology residency at the Mayo Clinic College of Medicine in Phoenix, Arizona and was a Mayo Clinic Scholar. During her Endourology fellowship at the Glickman Urological & Kidney Institute at the Cleveland Clinic, she was awarded the Urology Fellow Teacher of the Year in 2019.

Dr. Stern specializes in the medical and surgical management of complex stone disease. At the Mayo Clinic, Dr. Stern oversees the multi-disciplinary stone clinic which incorporates urology, nephrology, and dietetics in the management of recurrent stone formers. Dr. Stern’s surgical practice includes complex ureteroscopy, percutaneous nephrolithotomy (PCNL), mini-PCNL, and ultrasound-guided percutaneous access for PCNL. Dr. Stern is involved in multiple ongoing clinical trials and is part of the Endourology Disease Group for Excellence (EDGE) and Collaborative for Research in Endourology (CoRE) research consortiums.

Dr. Stern is the Program Director for the Endourology Fellowship at Mayo Clinic Arizona and takes an active role in medical student, resident, and fellow education. She is active within the American Urological Association and serves on the Legislative Affairs Committee and Public Policy Committee.

Talks by Karen L. Stern, MD

Point-Counterpoint: Next Generation Sequencing vs. Standard Culture – Standard Culture

Posted by Karen L. Stern, MD | Sep 2023

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.”

Point-Counterpoint: 24-Hour Urine Tests vs. Empiric Therapy – 24-Hour Urine Tests

Posted by Karen L. Stern, MD | Sep 2023

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.”