It is estimated one in 10 people will have a kidney stone at some point in their life. Three new studies being presented this year during the 2021 American Urological Association (AUA) Annual Meeting demonstrate new trends in kidney stone patient care, including over-the-counter products and a new technique utilizing ultrasound. These studies were presented during a virtual press session, which was moderated by AUA Spokesperson, Dr. James Borin. The recording of this session is now available for viewing.
Publication # MP18-07
Ultrasound to Reposition and Accelerate Passage of Distal Ureteral Stones
Patients presenting with a distal ureteral stone underwent ultrasonic propulsion alone or ultrasonic propulsion and intermittent burst wave lithrotripsy (BWL) to facilitate stone passage and relieve pain. During this treatment all participants were awake without anesthesia and underwent a screening ultrasound, pre – and post – procedure pain assessment, 3 week follow up to report any adverse events and follow up imaging within 12 weeks.
Key Findings:
- 93% of acute stones passed in an average of 3.6 days post-procedure.
- Adverse events were limited to slight reddening of the skin, hematuria on only the initial urination post-procedure and a mild sensation, similar to a pinprick, on fewer than 10 of 620 propulsion bursts among 3 of 20 subjects.
- There is potential for facilitating stone page of distal ureteral stones and relieving pain with ultrasonic propulsion and BWL.
Publication # PD21-12
Clinical Comparison of Non-Prescription Over-the-Counter Urinary Alkalinizing Agents: Effects on Urinary Citrate Excretion and Urine pH
Prescriptive urinary alkalinizing agents are expensive and many patients request alternatives to help with low urine citrate and pH levels to prevent kidney stones. The authors of this study compared two over-the-counter products, baking soda and LitholyteÒ on patients with low urine citrate, pH or both. Patients completed a 24-hour urine collection, side-effects survey and Wisconsin Stone Quality of Life questionnaire during the last weeks of the 90-day treatment.
Key Findings:
- Baking soda and LitholyteÒ products increased urine citrate and pH without increasing calcium. All changes were clinically relevant.
- Follow-up prevelance of low urine citrate, pH or both was slightly lower on patients who used baking soda than those who use LitholyteÒ.
- Stone-related quality of life improved by 10 percent in both groups and the largest improvement was in disease symptoms.
Publication # PD21-07
Effect of a High Citrate Beverage on Urine Chemistry in Kidney Stone Formers
Moonstone is a high citrate, over-the-counter beverage designed to prevent recurrent kidney stones. Popular lore has promoted citrus juice for stone prevention, but the amount required to have meaningful benefits (increased urine citrate and pH) is not well-established. Thus, there are no evidence-based beverages that serve as an alternative to water, designed to increase urine volume and alter urine chemistry, in order to achieve stone prevention. We sought to demonstrate the effects of Moonstone on urine chemistry in a group of stone formers of various compositions.
Key Findings:
- Compared to water, Moonstone caused an increase in 24h urine citrate from 469.1 + 231.9 mg/d to 635.4 + 349.1 mg/day. 24h urine pH went up from 6.21 + 0. 78 to 6.61 + 0.69.
- Patients preferred Moonstone as a stone prevention regimen compared to water alone or Urocit-K.
- Two packets of Moonstone caused increases urine citrate and urine pH. The effect on pH would also be expected to benefit patients with uric acid and cystine stones.
“More than one million Americans are diagnosed with a kidney stone each year,” Dr. Borin said. “It is important to stay abreast of the latest developments in kidney stone prevention and treatment in order to help our patients avoid the morbidity of a kidney stone event.”
