Donaldson JF. et al., 2021: Evidence and clinical trials in Endourology: where are we going
Donaldson JF, McClinton S.
Academic Urology Unit, University of Aberdeen.
2Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Purpose of review: There is an ongoing explosion in the amount and quality, of research in the field of Endourology. From a solid basis of systematic reviews and small, single centre trials it has been possible to design large randomised controlled trials in the UK and in the USA. This review will describe some of the more recent trials (small and large) that are helping to provide a solid evidence base for our practice in Endourology.
Ongoing studies: Randomised controlled trial (RCTs) include: The Therapeutic Interventions for Stones in the Ureter (TISU), the Percutaneous nephrolithotomy, flexible Ureterorenoscopy and extracorporeal Shockwave lithotripsy for lower pole kidney stones (PURE RCTs) and the Prevention of Urinary Stones with Hydration (PUSH). Quality of life (QoL) measures and studies include: the Wisconsin Stone QoL Questionnaire, the Cambridge Renal Stone PROM, the Cambridge Ureteral Stone PROM, the Urinary stone and Intervention QoL questionnaire and the Study to Enhance Understanding of sTent-associated Symptoms (STENTS). The Core Outcome Set in Trials on treatments for Renal and UreteriC sTones (COSTRUCT) study aims to define a core outcome set to be used in future trials.
Summary: On-going studies will provide higher quality evidence on the treatment of ureteric and renal stones to inform treatment decision making and guideline recommendations. They will also guide decisions relating to prevention and recurrence and give insight into the true impact of urinary stones and endourological interventions on patients' quality of life. Future studies will incorporate big data and artificial intelligence.
Curr Opin Urol. 2021 Mar 1;31(2):120-124. doi: 10.1097/MOU.0000000000000851. PMID: 33399369.
This article is a thoughtful information on modern research efforts.
There is a summary of some carefully planned on-going studies on:
1. Treatment of lower pole renal stones 2021) .
3. Comparison of individualized and standard fluid intake for prevention of stone recurrences.
4. QoL studies that are considered of utmost importance for recommendations on decisions on whether stents or percutaneous nephrostomy catheters should be preferred for decompression.
Most interesting is it that in the future, invaluable information can be expected from “Big Data” bases analysed by AI.
When all these on-going and carefully conducted future studies come true, they will have a pronounced influence on decision making and formulation of guidelines. Particularly interesting will it be to see the results of stone recurrence prevention in large well controlled studies.
The extensive research efforts described above for evaluation of the outcome of various treatment procedures hopefully will reduce the need of repeated systematic literature reviews that currently constitute a significant part of the urological literature.