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    Endourology/Stones: Care utilization for stones growing rapidly in older adults

     

    • Good glycemic control in stone formers with diabetes reduced risk factors for uric acid calculi.

    • Differences in the upper urinary tract microbiome in urinary stone patients were strongly associated with patient age and stone type.

    • Limitations of sequencing platforms should be considered in microbiome studies of urologic diseases because different sequencing platforms can underestimate microbiome diversity and exhibit significant compositional differences.

    • Antibiotic treatment in rats affected the gut microbiome and was associated with increased urinary calcium excretion.

    • In another animal model, oxalate exposure exhibited broad stimulatory and inhibitory effects on the metagenome of the gut microbiome beyond just that of oxalate-degrading bacteria.

    • Prior antibiotic exposure was strongly associated with increased odds of incident kidney stones, and the greatest risk occurred with more recent and early life exposure.

    • Results of two randomized controlled trials showed no benefit for prolonged antibiotic use in patients at low risk for infection-related complications undergoing percutaneous nephrolithotomy (PCNL).

    • PCNL is a feasible alternative to nephrectomy to preserve ipsilateral renal function in select patients with xanthogranulomatous pyelonephritis, but postoperative infectious complications are common.

    • Outpatient PCNL is safe and feasible.

    • Physicians practicing at academic institutions or who are fellowship trained in North America or Europe are most likely to perform PCNL in patients on aspirin.

    Next: Continuing aspirin in patients undergoing PCNL

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