AUA 2026: Updates on Stone Disease

Reduced Likelihood of Post-Operative Urinary Tract Infection with Single-Use Ureteroscope with Real-Time Infrarenal Pressure Monitoring Vs. All Other Single-Use Ureteroscopes for Patients with Kidney Stones

Authors: Naeem Bhojani, Kathryn Morris, Jenifer White, Sirikan Rojanasarot, Emma D. Tran, and Manoj Monga

This retrospective cohort study evaluated post-operative urinary tract infection (UTI) rates after ureteroscopy (URS) using the LithoVue™ Elite single-use digital flexible ureteroscope (LVE) with pressure monitoring compared with other single-use ureteroscopes without pressure monitoring. Using Truveta electronic health record data, 208 patients treated with LVE were matched with 416 patients treated with other single use ureteroscopes. Mean age was about 61 years, and about 48% of patients were female in both groups. At 30 days after URS, post-operative UTI occurred in 5.2% of patients treated with LVE with pressure monitoring compared with 10.8% of patients treated with other ureteroscopes (p=0.033). Multivariable analysis showed a significantly higher likelihood of 30-day UTI with other single-use ureteroscopes compared with LVE with pressure monitoring (odds ratio [OR] 2.41; 95% confidence interval [CI]: 1.21–5.27; p=0.020). Overall, use of LVE with pressure monitoring was associated with lower rates of post-operative UTI after URS.

Are SGLT2 Inhibitors a New Risk factor for Urinary Tract Infections After Ureteroscopy in Diabetic Patients?

Authors: Nicola Fazaa, Reut Shashar, Etan Eigner, Melissa Atallah, Ameer Nsair, Michael Mullerad, Gilad Amiel, Oleg Goldin, Yoel Soloveichik, Yoav Stabholz, and Omer Sadeh

This retrospective study evaluated whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) use increases the risk of postoperative urinary tract infection (UTI) in diabetic patients undergoing ureteroscopy (URS). Among 1,220 diabetic patients who underwent URS between 2018 and 2024, 213 (17.5%) were receiving SGLT2i therapy before surgery. Postoperative UTI within 30 days occurred more frequently in SGLT2i users compared with non-users (21.1% vs 12.1%; p<0.001). On univariate analysis, SGLT2i use was associated with a higher risk of postoperative UTI (odds ratio [OR] 2.36). A positive preoperative urine culture was identified as the strongest predictor of postoperative UTI (OR 4.05). Propensity score-matched analysis confirmed the independent association between SGLT2i use and postoperative UTI risk (OR 2.18). Intensive care unit (ICU) admission was rare but occurred twice as often in SGLT2i users compared with non-users (0.02% vs 0.01%). Overall, SGLT2i therapy was associated with an increased risk of postoperative UTI after URS in diabetic patients.

Predictors of Failure after Endoscopic Management of Iatrogenic Ureteral Strictures

Authors: Stefano Moretto, Olivier Traxer, Alberto Saita, Bhaskar K. Somani, Evangelos Liatsikos, Esteban Emiliani, Andreas Skolarikos, Leye Ajayi, Amelia Pietropaolo, Steeve Doizi, Vincent De Coninck, Panagiotis Kallidonis, Tarik Emre Sener, Eugenio Ventimiglia, Daniel Pérez-Fentes, Pietro Acquati, Frederic Panthier, Luca Villa, Iulia Andras, Mauro Ragonese, Anil Shrestha, Senol Tonyali, Lazaros Tzelves, and Nicolò Maria Buffi

This multi-center retrospective study evaluated risk factors for failure after endoscopic treatment of iatrogenic ureteral strictures (IUS) that developed following ureteroscopic treatment for urinary stones. Among 101 patients, successful outcomes were achieved in 63 patients (62%), while 38 patients (38%) required reintervention after primary treatment. Treatment approaches included balloon dilation alone (n=43), laser endoureterotomy alone (n=31), combined laser and balloon treatment (n=21), and ureteral dilators (n=6). On multivariate analysis, residual stone fragments at the stricture site were independently associated with treatment failure (odds ratio [OR] 7.41; 95% confidence interval [CI]: 2.25–26.3; p=0.001). Balloon dilation alone was also associated with higher failure risk compared with combined laser and balloon treatment (OR 3.70; 95% CI: 1.10–13.9; p=0.041). Proximal ureteral stricture location showed a trend toward increased risk of failure (OR 2.50; 95% CI: 0.90–7.10; p=0.074). Overall, residual stone fragments and use of balloon dilation alone were identified as predictors of recurrence after endoscopic management of IUS.

Stone Treatment for Patients with Recurrent UTIs and Concurrent Non-obstructing Kidney Stones: Does It Matter?

Authors: Amber S. Herbert, Matthew Kim, Calvin Z. Zhao, Daniel G. Wong, John T. Leppert, Simon Conti, Joseph C. Liao, Timothy C. Chang, and Ryan R. Sun

This single-center study evaluated outcomes after surgical removal of asymptomatic kidney stones in patients with recurrent urinary tract infections (rUTIs). A total of 112 patients with rUTIs and kidney stone disease (KSD) underwent definitive stone treatment between 2019 and 2023. Mean stone size was 12 ± 10 mm. During 1-year follow-up, 101 patients (91%) were free from recurrent UTIs, and 73 patients (61%) had no symptomatic UTI recurrence. Stone composition included calcium oxalate monohydrate (45%), calcium oxalate dihydrate (27%), calcium phosphate (54%), struvite (21%), and uric acid (6%). Patients with initial stone burden ≤5 mm, residual stones after treatment, Enterococcus infection, or multiple organisms on preoperative urine culture were less likely to achieve complete resolution of recurrent UTIs (p<0.05). Residual stones and multiple organisms on urine culture were independently associated with unresolved recurrent UTI during follow-up. Overall, definitive stone removal was associated with substantial reduction in recurrent UTIs in patients with concurrent kidney stones and rUTIs.

Effect of Preoperative Silodosin on Outcomes of Ureteroscopy for Ureterolithiasis: A Systematic Review and Meta-Analysis

Authors: Nathan Joseph Silva Godinho, Caio Hernandes Colhado, Lucas De Amorim, Marco Antonio S. Andrade, Thales Henrique, S. Figueiredo Menezes, Samuel Elias Marinho Da Costa, Michael Lipkin, and Eduardo Mazzucchi

This systematic review and meta-analysis evaluated the efficacy and safety of preoperative silodosin in patients undergoing ureteroscopy (URS) for ureteral stones. Nine studies, including eight randomized clinical trials, involving 960 patients were analyzed. Among them, 450 patients (46.8%) received silodosin before URS. Compared with controls, silodosin significantly reduced ureteral wall injuries (risk ratio [RR] 0.30; 95% confidence interval [CI]: 0.18–0.49; p<0.00001) and shortened operative time by a mean of 17.72 minutes (p<0.00001). Silodosin also reduced analgesic requirements (RR 0.35; 95% CI: 0.16–0.75; p=0.007). Trends toward lower postoperative fever and hematuria rates were observed, although these did not reach statistical significance. In studies with at least 10 days of preoperative treatment, silodosin significantly improved stone-free rates (SFR) (RR 1.17; 95% CI: 1.10–1.26; p<0.00001). Subgroup analysis showed improved SFR for distal ureteral stones, while proximal stones showed lower ureteral wall injury rates. Overall, preoperative silodosin improved safety and operative outcomes in patients undergoing URS for ureterolithiasis.

AUA 2026, May15 – 18, Washington, DC.