EAU17: Stones: Emerging data and emergency treatment

The 32nd Annual EAU Congress came to a close on Tuesday morning with its final plenary session. For three hours, delegates were updated on emerging trials, differing approaches and specialized lectures on that most urological of topics: stones. The session was chaired by Scientific Congress Office Chairman Prof. Arnulf Stenzl (DE), who could look back on a creating successful weeklong scientific programme with his team, and Prof. Thomas Knoll (DE), EULIS member and renowned urological stones expert.

Dr. Beat Roth (CH) was the first speaker, introducing the Swiss Kidney Stone Cohort (SKSC), a prospective multi-centre study which has been gathering participants since its start in 2014. Following a period of “maximal recruitment”, the SKSC is now aiming for 1000 patients, a sufficiently robust but manageable number of patients for the centres involved.

The data collected from the Swiss stone patients includes anthropomorphic and socio-economic data, standard chemical and hormonal urine and blood analysis, analysis of cristalluria, food intake and physical activity assessments and the biobanking of blood samples, DNA and urine samples.

The study is designed to examine questions that still confront stone specialists, like whether or not the stone patient is at risk for chronic kidney disease, if the calcium stone patient is at risk of bone disease, and if stone composition changes after certain treatments, like SWL.

The enrolment has currently grown beyond 400 patients, allowing the first studies of the collected data and biological samples to take place. One project that examines the impairment of urine pH by SWL was presented at EAU17 as Abstract 44. Calls are open to access the data and samples of the SKSC, though investigators have to secure their own funds for research.

The patient in pain: acute treatment

What followed was a debate on the merits of four possible approaches for a patient presenting with acute ureteral stone pain. Dr. Stefano Picozzi (IT) discussed emergency ESWL, Dr. Juan Galan Llopis (ES) defended the advantages of emergency URS, Dr. Thomas Lam (GB) examined alpha blockers and Prof. Andreas Johannes Gross (DE) made a short but firm case for stenting. Gross argued that the other procedures either required stenting anyway, took too long for acute pain or required follow-up.

Picozzi pointed to ESWL’s “satisfactory” stone-free rate and effective pain relief, its safety and the fact that it is well-tolerated by patients. There might be some concerns about its effectiveness in an emergency setting, as well as the potential for overtreatment and related waste of resources. In the discussion which followed, Lam conceded that alpha blockers may not provide immediate relief for the patient, but were nevertheless a valid option for stones that were not too small to pass, or too large to cause severe pain and trauma.