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Articles

"Glean will enable patients to void naturally, without catheters in place. I believe this advance will yield a better test that mimics actual symptoms," says Bilal I. Chughtai, MD. 

FDA grants 510(k) clearance to Glean Urodynamics System

professor and chair of urology at the University of Oklahoma Health Sciences Center in Oklahoma City, is co-editor in chief of 

"We must lobby to maintain our current funding levels and push for increased support to continue driving progress in cancer care," says Michael S. Cookson, MD, MMHC, FACS.

The importance of federal funding in cancer research: A call to action

“The data presented at EAU25 add to the growing body of evidence supporting the CVAC System as the emerging standard of care in kidney stone removal,” says Brett Johnson, MD. 

CVAC2 shows safety, efficacy for stone clearance in real-world study

A recap of the FDA submissions and regulatory decisions in urology from March 2025.

FDA updates in urology: March 2025

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Clinical Focus

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

® Assistant Editor Janelle Hart spoke with 

 They discuss the association between kidney stones and climate change, and what the projections of their recent study evaluating this relationship will mean for future generations. Tasian is an associate professor of surgery and epidemiology at the University of Pennsylvania Perelman School of Medicine, a pediatric urologist at the Children’s Hospital of Philadelphia, and Director of Pediatric KIDney Stone (PKIDS) Care Improvement Network and Kaufman is a medical student at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania.

“The prevalence of kidney stones has increased over 80% over the last 30 years, and the epidemiology has changed such that it's beginning at a younger age now,” says Gregory Tasian, MD, MSc, MSCE.

Why kidney stones will become more prevalent over time

s® Managing Editor Ben Saylor spoke with 

 study, "Multi-institutional prospective randomized control trial of novel intracorporeal lithotripters: ShockPulse-SE vs Trilogy trial," for which she served as senior author. Krambeck is a professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

“You have tradeoffs with every device that you use,” says Amy E. Krambeck, MD.

Dr. Krambeck investigates efficacy of Trilogy and ShockPulse-SE lithotripters 

This episode’s guest is Amy E. Krambeck, MD. She discusses a recent Urology Practice paper, "Initial Experience With a Novel Single Use Disposable Ureteroscopy: A Prospective Single Arm 90-day Trial of the Axis Ureteroscope," for which she served as a study author. Krambeck is the Michael O. Koch Professor of Urology at Indiana University School of Medicine, Indianapolis.

Dr. Ranjith Ramasamy on nasal testosterone gel and sperm parameters

Dr. Amanda North on the gender pay gap in urology

Malpractice and stones: What a recent study reveals

On the latest episode of the Speaking of Urology podcast, Dr. Amy Krambeck discusses her recent study evaluating the Axis single-use ureteroscope.

Dr. Amy Krambeck discusses 90-day trial of disposable ureteroscope

This episode's guest is Peter L. Steinberg, MD. He discusses a recent 

 paper titled “Medical Malpractice and Nephrolithiasis: U.S. Appellate Cases From 2001- 2018,” for which he served as co-author. Steinberg is assistant professor of surgery at Harvard Medical School.

Dr. Finkelstein discusses telemedicine for pediatric post-op visits

What patients undergoing HIFU should expect postoperatively

Dr. Angela Smith discusses Jelmyto for low-grade UTUC


In this episode, Peter L. Steinberg, MD, discusses a recent Urology Practice paper that examined medical malpractice cases involving kidney stones.

Speaking of Urology - Malpractice and stones: What a recent study reveals

Calyxo has identified a new risk of injury when the CVAC System is used in patients with high viscosity fluid in their kidneys at the start of the procedure.

FDA reports Urgent Device Field Correction notice for CVAC Aspiration System

This announcement follows the successful launch of generic tiopronin delayed-release tablets last year.

Tiopronin delayed-release tablets available in US for patients with cystinuria

The overall prevalence of kidney stones remained stable, with a notable increase observed among women. 

Kidney stone prevalence is increasing in women, study findings show

A recap of the FDA submissions and regulatory decisions in urology from February 2025. 

FDA updates in urology: February 2025

In a recent study, investigators evaluated the use of tamsulosin (Flomax) in pediatric patients undergoing ureteroscopy.

 They reported that patients who received tamsulosin had an 87% chance of having a successful URS procedure, according to senior author Kate H. Kraft, MD, MHPE, FACS, FAAP.

The study findings indicate a significant age and body mass index difference between the tamsulosin and the no-tamsulosin groups. In an interview with 

®, Kraft was asked how she believed these factors might independently or interactively influence ureteral access and the observed tamsulosin efficacy.

“We definitely found a significant difference in the 2 groups. I think that comes with the limitation of this being retrospective. It looked like those who were in the tamsulosin group were taller, they weighed more, they had a larger BMI, and they were older. I think a lot of that has to do with prescribing practices among our colleagues. We feel very comfortable, in general, prescribing tamsulosin in older patients, because it's a capsule so they can swallow it, although the counter argument to that is you can't open the capsule and sprinkle the contents for children whodon't take pills,” said Kraft, chief of Pediatric Urology, Mark C. McQuiggan, MD, and Carolyn A. McQuiggan Research Professor, and professor of urology at the University of Michigan, Ann Arbor.

In a recent study, investigators evaluated the use of tamsulosin (Flomax) in pediatric patients undergoing ureteroscopy

Investigators evaluate tamsulosin use in pediatric patients 

Kraft also touched on the role of prescriber comfort and potential adverse events.

“Tamsulosin is associated with some possibility of hypertension or dizziness, and I think in a younger cohort, where it's more difficult to adjust the dose, pediatric urologists just don't feel as comfortable prescribing it,” Kraft said.

Kraft was also asked about the fact that although their findings demonstrated a statistically significant improvement in ureteroscopic access with tamsulosin, the absolute risk reduction was 11%.

“We recognize that an 11% increase in success may not seem that clinically significant, but I think every little bit helps. When we are unable to advance a flexible ureteroscope in a pediatric patient, really, the next alternative is to place a ureteral stent for passive dilation, and then that means another trip to the operating room in the future to make another attempt. And that's no small thing,” Kraft commented.

1. Meyer KM, Asantey K, Ellison JS, et al. The effect of preoperative tamsulosin on pediatric ureteroscopic access: A multi-institutional experience. 

2025 Feb 5:101097UPJ0000000000000793. doi:10.1097/UPJ.0000000000000793

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"We recognize that an 11% increase in success may not seem that clinically significant, but I think every little bit helps," says Kate H. Kraft, MD, MHPE, FACS, FAAP.

Recent study findings pointing to disparities in receipt of pain management for nephrolithiasis have led researchers to propose collaboration with emergency medicine colleagues and endourologists to develop pain management guidelines.

®, study author Hailey Frye explained, “Making sure that all parties involved, whether it was the urologist, the residents, but also our colleagues down in the emergency department, were included in these conversations was an important priority for us moving forward, and so we discussed and learned from our emergency department colleagues some of the different factors that go into managing pain in the acute care setting…Additionally, we talked about staffing and the ability to provide the check in on these patients, and so being able to balance some of these external factors and external limitations that come into play in the emergency department was something that we wanted to consider and wanted to help our emergency department colleagues consider and work with when developing these guidelines for pain management,” said Frye, a medical student at the University of Minnesota, Minneapolis.

Recent study findings pointing to disparities in receipt of pain management for nephrolithiasis have led researchers to propose collaboration with emergency medicine colleagues and endourologists to develop pain management guidelines

Pain management disparities in kidney stones point to need for guidelines, experts say

Frye was also asked about steps to take for advocating for change within health care systems.

“For other health care professionals aiming to advocate for equitable changes within their system, it's really important to just start conversations about what you're noticing, whether it is pain management or whether it's waiting time or access to care or access to the physical clinic itself, initiating conversations with colleagues and really prioritizing those values within the system I think is the first start,” Frye said.

She added, “We had a lot of data to drive this discovery and this finding, as far as readmission rates or who received these different prescriptions, but the 1 area that we wanted to expand further on and hope to is really the patient experience; what is it like to have to go to the emergency department with a kidney stone? And so thinking about all of those factors prior to implementing a framework is important in order to make sure that you give yourself and your hospital group the best shot to be able to make changes and minimize those disparities.”

1. Frye HH, Ganesan V, Agarwal D, Patterson B, Herman A, Borofsky MS. Need for pain management policies: Uncovering hidden biases in pain management of nephrolithiasis. Presented at: American Urological Association Annual Urology Advocacy Summit. March 3-5, 2025. Washington. https://www.auasummit.org/virtual-poster-session

"For other health care professionals aiming to advocate for equitable changes within their system, it's really important to just start conversations about what you're noticing," says Hailey Frye.

®, Perry Xu, MD, spoke about artificial intelligence’s potential in the field of endourology.

During the interview, Xu, assistant professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, spoke about the increasing prevalence of kidney stones.

“There's about a 10% chance of making kidney stones as an American, and that's in contrast in the past, where it used to be as low as 3% in the 1970s,” Xu commented. With this growing prevalence, there is a need for innovations such as AI to help with patient care.

“I think we can really use AI in several different facets of endourology. One of them, I think …is how to actually intelligently triage patients and be able to get them in to see a urologist as soon as possible,” Xu said.

Perry Xu, MD, shares several potential applications for AI in endourology

Perry Xu, MD, on the potential of AI in the endourology space

Another potential use of AI is to enhance currently available surgical treatment for kidney stones, according to Xu.

“There have been a lot of advancements in trying to find out stone compositions from video input alone, to better identify laser settings and how they can be modulated to better advance and treat stone disease in situ within the operation…there are a lot of new ideas and new measurements of intra renal pressures during kidney stone surgery as well, and how to actually use that to intelligently enhance the surgery as well,” Xu said.

A key element of kidney stone management is preventing them from forming in the first place, Xu said.

“I do think the most key thing for stone disease overall is prevention, because once we finish treating the stones, our patients don't want to make them again,” Xu said.

To this end, AI can also help with patient counseling regarding kidney stones; Xu mentioned that for patients who show a particular interest in their care, he recommends Dornier MedTech’s UroGPT tool.

“I think we can really use AI in several different facets of endourology," says Perry Xu, MD.

Use of preoperative tamsulosin (Flomax) in pediatric patients undergoing ureteroscopy appears to facilitate ureteroscopic access in this patient population, according to a recent study.

, senior author Kate H. Kraft, MD, MHPE, FACS, FAAP, described the background for the study.

“This study has been a long time in the making. Essentially, it was motivated by literature that came out in 2018 in adult urology that showed that tamsulosin potentially could help ureteral access. And so I thought, 1 unique problem that we have in pediatric urology is that we're operating on smaller urinary tracts, but we use the same equipment that our adult urologists use as well when it comes to flexible ureteroscopy. So I wondered if maybe there was a good way to help facilitate access,” said Kraft, chief of Pediatric Urology, Mark C. McQuiggan, MD, and Carolyn A. McQuiggan Research Professor, and professor of urology at the University of Michigan, Ann Arbor.

Kate H. Kraft, MD, discusses a study of pediatric patients undergoing URS

Kate H. Kraft, MD, discusses pre-op tamsulosin use in pediatric patients undergoing URS

Kraft and her coauthors conducted a multi-institutional retrospective review that included a total of 382 patients, “which is a pretty large number for pediatric urology study,” Kraft noted.

“Essentially, when we compared the 2 groups, those that received tamsulosin and those that did not, we did find a significant difference with regard to success rates. We ultimately found that those that took tamsulosin had an 87% chance of being able to have their ureteroscopy successfully performed, which is essentially an 11% increase compared to those that had not previously had tamsulosin. We recognize that there are a lot of limitations with a retrospective study, but this is a great next step in having the conversation about, is giving tamsulosin to our pediatric patients ahead of ureteroscopy going to make a clinical difference, and I think it potentially could,” Kraft reported.

"When we compared the 2 groups, those that received tamsulosin and those that did not, we did find a significant difference with regard to success rates," says Kate H. Kraft, MD, MHPE, FACS, FAAP.
.

Researchers from the University of Minnesota, Minneapolis, have uncovered disparities in pain management for patients with nephrolithiasis, in a study presented at the 2025 American Urological Association Annual Urology Advocacy Summit in Washington.

®, University of Minnesota medical student Hailey Frye described the background behind the study.

“The project really stemmed from conversations that we were having in clinic as far as how patients are being managed and how their care is being provided in the emergency department, before they came up and worked with the urologist for their kidney stones. [That] led to a discussion about overall disparities in care and disparities in medicine and in urology. The first step to addressing disparities is to identify them, so we aimed to characterize how socioeconomic factors and the likelihood of receiving opioids for pain management were related, specifically for kidney stones,” Frye said.

Hailey Frye describes a study presented at the American Urological Association Annual Urology Advocacy Summit

Study findings point to do disparities in pain management for kidney stones

She also described the methodology behind the research.

“Here at the University of Minnesota, we have a department called the Clinical Quality Outcomes Discovery and Evaluation Team…that basically takes a lot of information from our medical records, and we were able to create a database for everyone that came to the emergency departments in 2019 to 2022, across all 14 of our emergency departments. With that information, we're able to control for age, sex, race, primary language, and insurance type.”

In terms of notable findings, “We found that female patients, Black patients, and patients with non-private insurance had a decreased odds of receiving opioids,” Frye told 

She added, “When we first identified that, we really wanted to address that—not saying that opioids are the best form of treatment for pain management for kidney stones—but just that there was a difference going on between these different populations, and we wanted to see next steps could look like to address that difference.”

"We found that female patients, Black patients, and patients with non-private insurance had a decreased odds of receiving opioids,” says Hailey Frye.

Study findings point to disparities in pain management for kidney stones

 of Nationwide Children’s Hospital in Columbus, Ohio, shared key takeaways from the study, “Predictors of follow-up of pediatric stone patients after surgical intervention.”

Data from the study showed that 74.9% of patients in the study attended a post-operative visit. Having public insurance and living in a single-parent household, which may be indicators of low socioeconomic status, were associated with a lower rate of follow-up after pediatric kidney stone surgery (

 = .02, respectively). Patients who were seen in the urology clinic prior to their procedure were more likely to comply with follow-up (P = .02).

According to Dr. Ching, these findings underscore the importance of establishing a relationship with a urologist prior to surgery and speaking directly with patients about barriers they might be facing. One solution, she recommends, could be offering and sharing information about evening clinic hours that may be easier for working, single parents to attend.

She also indicated a need to better counsel patients about why they are being asked to return to the clinic following the procedure in the first place, as many may not understand the need to do so.

Christina B. Ching, MD, of Nationwide Children’s Hospital in Columbus, Ohio, shared key takeaways from the study, “Predictors of follow-up of pediatric stone patients after surgical intervention.” 

Christina Ching, MD, on overcoming barriers to follow-up after pediatric stone surgery

Additional data from the study looked at the rates of completed post-operative imaging and 24-hour urine testing. Data showed that the rate of completed imaging was around 80%. Patients with a larger total stone burden were more likely to undergo ordered imaging (

However, although recommended in American Urological Association guidelines, just under 70% of patients had an order for urine testing, and less than 50% underwent testing when they were ordered. According to Dr. Ching, this indicates a need for physicians to both follow the guidelines and assess why the completion rate is so low among patients. 

“We might need to do a better job in general about education of the importance of follow-up,” says Christina B. Ching, MD. 

Christina B. Ching, MD, shares key findings from the study, “Predictors of follow-up of pediatric stone patients after surgical intervention."

Christina Ching, MD, on predictors of follow-up after pediatric stone surgery

, shares key findings from the study, “Predictors of follow-up of pediatric stone patients after surgical intervention,” for which she served as the senior author. Ching is a clinical associate professor of pediatric urology at Nationwide Children’s Hospital in Columbus, Ohio.

Our primary outcome was to look at compliance with following up for a scheduled office visit after surgery. Then, we had 2 secondary outcomes, looking at completion of ordered imaging—post-op imaging specific to their kidney stones, like an ultrasound or CT scan—and then also completion of ordered 24-hour urine testing. What we found was pretty on par with the adult literature, which is what we were using, because that's really where the research has been done, is in the adult population. We found that about 75% of our patients came back for an office visit, which is on par with the adult literature, where it's anywhere from about 70% to 80% of adult studies reporting their retention of their patients after kidney stone surgery.

When we looked at what might be associated with poor follow-up or lack of a follow-up, we found that having public insurance and also being from a single-family home, those patients were less likely to follow-up. Interestingly, the patients that were more likely to follow-up were those patients that were seen and established within our urology clinic. So, the alternative is maybe they were seen in in the emergency room and taken to the operating room, as part of that encounter, or seen the emergency room [and] felt that they didn't need an emergent intervention, but from there, were scheduled for their surgical intervention, vs if they were actually seen in the urology clinic, because they were referred from another provider, or from the emergency room, were sent to the urology clinic to then subsequently have their surgery. We saw that being seen in the urology clinic led to a higher rate of those patients returning after their surgical intervention, pointing towards having established a relationship with those patients in a non-urgent or emergent setting helped predict and improve those patients coming back.

The other findings of a single-family home and public insurance can be metrics of lower socioeconomic status. That is interesting, because that data has been previously shown in the adult literature, of metrics of lower socioeconomic status being a potential metric for barriers to access to health care. In some of the adult literature looking at having public insurance, those patients ended up having a longer duration between when they presented with their kidney stone to actually undergoing surgery. Again, interesting to see that our data is actually following what has been previously reported, though in a different patient population.

For both obtaining the ordered imaging and the ordered urine studies, we similarly found that having public insurance and also being from a single-family home, that patient population was less likely to complete the imaging and the urine studies, again, confirming what we what we found from the office visits. One opportunity that we noticed was even ordering the urine studies; we had a higher rate of having appropriate orders in for post-op imaging and things like that. But, even though it's an AUA guideline to obtain urine studies, we found that just under about 70%, about 60%-65% of our patients had orders for urine studies. That identifies an opportunity for [us as] providers to follow the guidelines. Actually, the number of patients completing urine studies was also very low. That itself is just very interesting. Less than 50% of our patients went on to get the urine studies when they were even ordered in the first place. So, again, it identifies a potential opportunity to see, why is that? Why are we not ordering urine studies when maybe we should? But also, why is the completion rate so low? Our completion rate of appropriate imaging was about 80% so that's actually really encouraging. I mean, obviously we'd like everybody to get the appropriate follow-up imaging, but that was at least higher for compliance of obtaining the imaging than their urine studies.

This transcript was AI generated and edited by human editors for clarity.

“Interestingly, the patients that were more likely to follow-up were those patients that were seen and established within our urology clinic,” says Christina B. Ching, MD.

Christina B. Ching, MD, describes the background and rationale for the study, “Predictors of follow-up of pediatric stone patients after surgical intervention."

Christina Ching, MD, on study of follow-up after pediatric stone surgery 

, describes the background and rationale for the study, “Predictors of follow-up of pediatric stone patients after surgical intervention,” for which she served as the senior author. Ching is a clinical associate professor of pediatric urology at Nationwide Children’s Hospital in Columbus, Ohio.

Our institution was one of the sites of the PKIDS study, which was a multi-institutional study looking at the outcomes of surgical intervention for kidney stones in pediatric patients. It's a really impressive study of, I believe, over 30 institutions that collected their data, looking at all pediatric patients undergoing kidney stone interventions and looking at the comparative effectiveness of those interventions on outcomes of kidney stones. This type of study has never been done before. We were really fortunate to be included as one of the sites.

It was actually my clinical research coordinator who was involved in the study, Nora Thompson. As part of the study, the patients had to come back for follow-up [and] get imaging so we could see the outcome of their surgical intervention. She mentioned to me at times, finding it difficult to get patients to return. So, we started talking about it, and was like, “wouldn't that be great if we could identify if there was something that could predict who would be able to follow up?" We decided to start looking in the literature, and there's not a lot about pediatric patients and what can predict access to care, and particularly, again, follow-up after surgical intervention for kidney stones.

We know that that's important because follow-up allows us to see the outcome of surgery. It allows us to evaluate for any complications after surgery, specifically, if there was maybe silent damage to the urinary tract that could lead to obstruction from their intervention, look at the efficacy of clearing their stones, potential for developing new stones, and an opportunity to start educating patients, if not able to do that before surgery, about their risks for developing future stones. About half of patients who develop kidney stones will have a recurrence within 3 years after developing their stones. We felt like, not only for the study, but for providing good care, that it was important to try and have these patients’ follow-up and see if we could identify factors that might impact their follow-up. From that, we decided to look at our own data and see, over a 5-year period, what our return to clinic visit rate was, and then, out of that, also who went on to get imaging and do some other important elements of follow-up, like completing urine studies to try and address why they made their kidney stone in the first place. That was the rationale and the origin of why we decided to look at what we looked at.

“We felt, not only for the study, but for providing good care, that it was important to try and have these patients follow-up and see if we could identify factors that might impact their follow-up,” says Christina Ching, MD. 

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