EULIS session stresses diversity of stone disease

12 April 2014

The well-attended session of the EAU Section of Urolithiasis (EULIS) highlighted the heterogeneity of the condition by examining various aspects of stone disease. Gender aspects were discussed in relation to diagnosis, treatment, and prophylaxis. The advantages and disadvantages of percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS) and multi-tract PCNL versus single-tract were also debated.

The traditional gender gap in the incidence of urolithiasis is closing now that more women are forming stones. Dr. Mehmet Özsoy (Vienna, AT) presented data which suggest that obesity may be the reason for the changing trend. He further mentioned that women have a greater risk of complications as a result of increased risk of urinary tract infections.

As diet adaptation is an effective prophylaxis in both sexes, Özsoy stressed the importance of increased public awareness of the ways to prevent stone formation with lifestyle changes and dietary adjustments.

Dr. Noor Buchholz (London, GB) argued that PCNL is the best option for any stone larger than 2 cm, rather than RIRS – which he said is less effective for larger stones. Improving the PCNL technique with flexible scopes and instrument minimisation will make PCNL the best treatment option for even smaller stones. Buchholz also predicted that technical innovations in RIRS will make it suitable for larger stones in the future.

Prof. Thomas Knoll (Sindelfingen, DE) and Dr. Cesare Scoffone (Turin, IT) discussed multi-tract PCNL. Knoll suggested that it is effective in experienced hands as a valid treatment option in very difficult cases, such as large staghorn stones.

Scoffone opposed this by saying that multiple tracts increase the risk of bleeding and renal scarring. He argued in favour of endoscopic combined intrarenal surgery (ECIRS), instead.

To conclude the session, Prof. Palle Osther (Fredericia, DK) presented the latest evidence-based guidelines. “Stone disease is a diverse disease for which you need both evidence and good clinical experience – neither is good enough on its own”, Osther said.

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