Manoj J. Monga, MD, FACS

Manoj J. Monga, MD, FACS

The University of California, San Diego

San Diego, California

Manoj J. Monga, MD, FACS, is Professor and Chair of Urology at the University of California, San Diego. He previously served as Director of the Stevan B. Streem Center for Endourology & Stone Disease at the Glickman Urological and Kidney Institute at the Cleveland Clinic and the Joseph Sorkness Family Endowed Professor and Vice-Chair of Urologic Surgery and Director of Endourology & Stone Disease at the University of Minnesota. Dr. Monga received his medical degree from the Chicago Medical School and completed his residency at Tulane University School of Medicine. Dr. Monga is recognized as an international authority in endourology and stone disease, and has been an invited speaker in India, Thailand, Brazil, Italy, Greece, Mexico, China, United Kingdom and the Netherlands. He has also acted as a Visiting Professor at many of the major medical centers in the United States. Dr. Monga has served on numerous AUA committees, including the Quality Improvement & Patient Safety Committee, Abstract Committee, and Urology Care Foundation’s Outreach Committee. He also served as Chair of the North Central Section’s Education Committee. Dr. Monga has served as the section editor of the Journal of Endourology and served on several other editorial boards, including the Indian Journal of Urology and the International Brazilian Journal of Urology.

Disclosures:

Talks by Manoj J. Monga, MD, FACS

Stone Disease Workup and Treatment

Stone Disease Workup and Treatment

Posted by | 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.

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

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

Posted by | 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

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

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

Posted by | 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.

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Mini PCNL versus Standard PCNL

Posted by | Mar 2022

Manoj J. Monga, MD, FACS, Professor and Chair of Urology at the University of California, San Diego, compares mini percutaneous nephrolithotomy (mini PCNL) for renal stone removal to standard percutaneous nephrolithotomy (PCNL). He begins by looking at who needs a PCNL, explaining that he typically performs them on patients with a stone larger than 15mm, but that he also sometimes performs PCNL on stones when there are anatomical considerations that would make it difficult to get to the stone ureteroscopically. Dr. Monga notes that PCNL has the best outcomes and results in the best quality of life of any stone removal technique. He then poses the question: Why not treat every stone with PCNL? The answer, of course, he says, is because 4/1000 patients die from PCNL due to sepsis. Dr. Monga then moves on to discuss mini PCNL, noting that it was originally assumed to potentially be safer than PCNL, but that a 2001 study showed there was no advantage. He also observes that the smaller sheath used in mini PCNL actually increases the risk of infectious complications, and that outcomes are worse and operating room time is longer with mini PCNL compared to standard. However, Dr. Monga notes, there does appear to be a lower risk for bleeding and fewer transfusions, which might result in less kidney volume loss.

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Asymptomatic Stones: Treat or Observe?

Posted by | Mar 2022

Manoj J. Monga, MD, FACS, Professor and Chair of Urology at the University of California, San Diego, suggests a situational approach to asymptomatic renal stone treatment based on outcomes data. Dr. Monga explains that asymptomatic renal stones are very common and are diagnosed in some 2 million patients per year. He notes that asymptomatic stones cause significant psychological distress in patients, and in fact tend to worry more than other stone patients. Dr. Monga also clarifies that asymptomatic stones often do not remain asymptomatic, citing data published in the Journal of Endourology showing that 26% of patients ultimately require intervention, 48% experience pain, 55% experience stone growth, and 77% experience any of the previously stated outcomes within 4 years of an asymptomatic stone being identified. He then shows that risk can be further stratified based on stone size and location, explaining that a stone in the renal pelvis is guaranteed to progress while a small upper pole stone is more likely to pass. Dr. Monga states that in most cases asymptomatic stone patients should be treated. He then summarizes the different treatments available for renal stones, observing that patients tend to select the less-invasive shockwave treatment over ureteroscopy even though it is less effective. He states that shockwave treatment’s efficacy varies based on the location and size of the stone, and that this should be discussed with patients. Dr. Monga concludes that stones less than 4mm should be observed and those between 4mm and 10mm should undergo shockwave treatment, while larger stones may require ureteroscopy.

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