Manoj J. Monga, MD, FACS, FRCS, Author at Grand Rounds in Urology

Controversies in Percutaneous Nephrolithotomy

Manoj J. Monga, MD, FACS, FRCS | Aug 2024

Manoj J. Monga, MD, FACS examines the indications for PCNL, emphasizing the criteria that influence the decision to opt for this invasive treatment. He highlights differing opinions on patient selection and the importance of individualized treatment plans.

Dr. Monga focuses on the technical aspects of PCNL and various approaches and techniques. He reviews the debate over the optimal access points, upper pole versus lower pole entry, and the risks and benefits of miniaturized versus standard tracts. He analyzes outcomes related to stone clearance rates, complications, and recovery times. Dr. Monga further explores the controversies in postoperative management, particularly the use of nephrostomy tubes versus tubeless procedures.

Emerging technologies and innovations in PCNL are also a key part of this presentation. Advancements in imaging techniques, new instruments, and their potential to enhance the safety and effectiveness of the procedure are examined, as well as the need for ongoing research.

Stone Disease Workup and Treatment

Manoj J. Monga, MD, FACS, FRCS | Oct 2023

Manoj J. Monga, MD, FACS, answers patients’ commonly asked questions about food, drink, and supplement choices for kidney stone prevention. He first acknowledges the overwhelming role of genetics in calcium oxalate stone formation. Dr. Monga then compares sodas made with phosphoric acid versus sodas made with citric acid, explaining the effects of each on stone formation, explaining that phosphoric acid is detrimental to the kidneys. He continues by analyzing the beneficial alkali content of coconut water and the impact of black and green teas on kidney stone formation.

Dr. Monga then addresses the role of dietary citrates, emphasizing that foods rich in citric acid are good for the kidneys, and foods rich in potassium citrate are bad for the kidneys. He also explains that a higher calcium and lower salt intake may help stone prevention. Dr. Monga considers supplements as well, noting that fish oil can help decrease urinary calcium while increasing urinary citrate.

Dr. Monga continues by evaluating several oxalate-rich foods, all of which raise the risk of stone formation. He completes his discussion with a comparison of milk chocolate versus dark chocolate, emphasizing that milk chocolate is better for reducing the risk of stone formation.

Point-Counterpoint: Mini-PCNL vs. Standard PCNL – Standard PCNL

Manoj J. Monga, MD, FACS, FRCS | Sep 2023

Manoj J. Monga, MD, FACS, compares mini percutaneous nephrolithotomy (mini-PCNL) for renal stone removal to standard percutaneous nephrolithotomy (PCNL). He discusses the different risks and benefits of mini PCNL versus standard, finding in favor of the more reliable and less expensive standard PCNL.

In this presentation, Dr. Monga discusses:

The history of Mini PCNL and Standard PCNL
Increased sepsis and other infection risk in Mini PCNL patients
Which variables are predictive of post-operative success

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

Manoj J. Monga, MD, FACS, FRCS | Sep 2023

Manoj J. Monga, MD, FACS, presents his argument for empiric therapy over 24-hour urine testing in kidney stone evaluation. Dr. Monga begins by explaining empiric therapy, including empiric dietary therapy, and describes it as a conservative treatment plan. He displays data on the effects of drinking fluids on reducing recurrence of kidney stones, as well as the positive effect of fruit and vegetable intake in terms of reducing kidney stone recurrence.

Dr. Monga then shifts gears to empiric medical therapy, displaying encouraging study data on the use of thiazides to reduce stone recurrence. He also displays data on citrates and stone recurrence, pointing out that this data is weaker, and asserting that citrates should not always be used with patients with kidney stones.

Dr. Monga acknowledges that not many stone patients—even high-risk stone patients—get a 24-hour urine test and that number is actually dropping. He also displays data showing that the use of a 24-hour urine test has no bearing on three-year recurrence across patient populations. Dr. Monga concludes by citing this lack of supporting data for the 24-hour urine test, and re-emphasizes the ease, speed, and efficacy of empiric therapy for patients suffering with kidney stones.

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