Perspectives in Urology: Point-Counterpoint Archives

Assessment of the Urinary Microbiome

Posted by Jennifer T. Anger, MD, MPH | Oct 2023

Jennifer T. Anger, MD, MPH, discusses microbiome assessments and the ongoing debate between cultures and next generation sequencing. She highlights the connection between acute symptoms and the potential presence of undetectable microorganisms in traditional culture methods, which underscores the need for more advanced technologies.

Dr. Anger introduces PCR and next generation sequencing as promising alternatives to culture-only assessments, offering higher sensitivity and comprehensive evaluation of the urinary microbiome. By utilizing these methods, a wider range of bacterial and fungal DNA can be detected, providing a more thorough understanding of the microbial composition.

Dr. Anger then addresses concerns of over-treatment and the implications of identifying microbial DNA without certainty of viability or pathogenicity. By understanding patients’ microbial composition comprehensively, there is potential for improved diagnosis and targeted treatment options for various diseases and conditions.

Stone Disease Workup and Treatment

Posted by Manoj J. Monga, MD, FACS | 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.

Developing Clinical Pathways to Improve Management and Outcomes in Women’s Health

Posted by Shirley H. Lee, CRNP-FNP, MPH | Oct 2023

Shirley H. Lee, CRNP-FNP, MPH, discusses developing clinical pathways to improve management and outcomes in women’s health, defining clinical pathways as the translation of complicated algorithms into efficient clinical workflows. Lee then explains the many treatment options for overactive bladder (OAB) for female patients, stating that 80 percent of patients are unsatisfied with their medication at six months, and asserting that clinicians must do a better job at successfully moving patients through the clinical pathway.

She then breaks the OAB clinical pathway into levels based on the invasiveness of treatment, and points out the importance of diagnostics between each of these levels in effectively tailoring treatment to individual patients. Lee explains that the clinical pathways can standardize care, leave fewer data gaps, and allow for earlier detection of treatment efficacy.

She then delves into a case study to illustrate the importance of a guided survey chart review whereby the navigator conducts an OAB symptom survey, instructs the patient on a voiding diary, and discusses OAB treatment options and follow-up. Lee explains the steps involved in executing clinical pathways for female patients, including establishing patient outcomes, ensuring that care pathways align with goals for those patient outcomes, and streamlining the workflow for all involved.

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

Posted by Manoj J. Monga, MD, FACS | 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: Mini-PCNL vs. Standard PCNL– Mini-PCNL

Posted by Karen L. Stern, MD | Sep 2023

Karen L. Stern, MD, explores the improved postoperative outcomes and increased cost-effectiveness of mini percutaneous nephrolithotomy (PCNL) compared to standard PCNL. Dr. Stern continues by pinpointing the specific advantages of mini PCNL, citing that blood loss, blood transfusion, and hospitalization rates all favor mini PCNL according to recent 2022 studies.

Dr. Stern notes that, while stone-free rates and fever rates are equivalent between mini and standard PCNL, meta-analyses comparing the outcomes of mini and standard PCNL tend to favor mini PCNL, even with larger kidney stones. Dr. Stern closes by exploring the capabilities of plastic vacuum sheaths and lower lithotripsy times of mini PCNL, emphasizing efficient stone removal and lower fever rates over that of standard.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Mini PCNL vs. Standard PCNL – Standard PCNL.”