What We Do

USDRN Research Highlights

The Urinary Stone Disease Research Network (USDRN) is a major collaboration between leading institutions in urinary stone disease research. Urologists, nephrologists, behavioral intervention specialists, pain specialists, and qualitative researchers are working together to conduct comprehensive research to help clinicians determine the best care options for urinary stone disease in both adults and children.

STENTS

Observational Cohort Study Overview

The STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) is a prospective, observational cohort study seeking to gain greater understanding of ureteral stent-associated symptoms among individuals undergoing stone treatment with ureteroscopy and ureteral stent placement. Enrollment for this trial began in March 2019 and ended in November 2021. The study enrolled 424 participants undergoing unilateral ureteroscopy with ureteral stent placement (including 40 adolescents) and 60 participants undergoing bilateral ureteroscopy with ureteral stent placement (484 total participants).

Research Highlights

This study provides several important and new findings that provide a foundation for patient-centered care and highlight potential targets for future efforts to mitigate the burden of stent-associated symptoms. This includes the development of the Stents Risk Calculator, a model used to predict a patient’s potential for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.

Key lessons from STENTS:

Ureteral stents inflict psychological harms on patients, including sleep disruption, mood disturbances, and inability to enjoy usual activities, while the stents are inside the patient. | Read the article
Most patients with ureteral stents experience the most severe symptoms in the first few days, and on average, the symptoms return to their preoperative baseline by one week after the procedure. | Read the article
Patient characteristics, rather than clinical or surgical factors, are associated with more severe symptoms. These patient factors include prior chronic pain conditions, prior severe stent pain, and psychological conditions such as depression or anxiety. | Read the article
Physiologic testing suggests that hypersensitivity to pain and a higher degree of central sensitization are associated with more severe symptoms. In other words, it is likely that the nervous system of patients with more severe symptoms is responding differently to the procedure and stent. | Read the article
Patients at risk for severe symptoms, such as pain, pain interference, and urinary symptoms, can be identified based on simple factors that are readily available before the procedure. | Read the article

PUSH

Clinical Trial Overview

The Prevention of Urinary Stones with Hydration (PUSH) is a randomized clinical trial designed to determine whether a multicomponent program of behavioral interventions to increase fluid intake would result in reduced risk of stone disease recurrence over a two-year period. This two-arm, randomized controlled trial incorporates pragmatic features, an adaptable intervention, patient choice, and remote monitoring of fluid intake through a “smart” water bottle that syncs with a mobile app to help people track how much water they drink. The study enrolled 1,658 participants with a history of urinary stones and monitored for recurrent symptomatic stones over the course of 24 months. Enrollment for this trial began in September 2017 and ended in May 2024.

Research Highlights

This study is the largest behavioral study ever conducted to date for stone disease prevention. Although the main results of the study were neutral, the study collected a wealth of data that could help better inform personalized prevention strategies that are realistic and achievable, which may include hydration, dietary changes, and potentially medications.

KEY LESSONS LEARNED FROM PUSH:

Despite the importance of high fluid intake to prevent stone recurrence, achieving and maintaining very high fluid intake is more challenging than we often assume for people with urinary stone disease | Read the article
The PUSH study streamlined data collection and participant adherence to the intervention by using a “smart” water bottle to track fluid intake and examining whether a combination of behavioral interventions (including a “fluid prescription”, financial incentives, and behavioral coaching) improved adherence to higher fluid intake and reduced stone recurrence. | Read the article
The behavioral interventions did help participants to increase their fluid intake (and urine output) over a 2-year period, but there was no difference in recurrence of symptomatic stones between the intervention and control groups. | Read the article
The primary outcome of symptomatic stone recurrence is a noteworthy aspect of the PUSH study. The investigators felt that it was very important to include an outcome that was clinically meaningful and important for patients, instead of simply looking at changes in urine output. | Read the article
Like so many other clinical research studies, the COVID-19 pandemic created numerous disruptions that have never before been experienced to the conduct of the PUSH trial. The PUSH team shared how they overcame the challenges imposed by a global pandemic. | Read the article

USDRN Research in the News

Largest Study of Its Kind Tests Hydration Strategy for Kidney Stones

Kidney stones can cause some of the most intense pain people ever experience, affecting daily life and leading many to hospital emergency visits. It affects 1 in 11 people in the U.S., and almost half will experience a recurrence. A major new study from the Urinary Stone Disease Research Network, coordinated by the Duke Clinical Research Institute, tested whether a behavioral program could help people drink enough fluids to prevent stones from coming back.

Behavioral hydration program falls short in reducing kidney stone recurrence

A multicomponent behavioral intervention designed to increase fluid intake did not reduce symptomatic recurrence of urinary stones compared with guideline-based care, according to results from the Prevention of Urinary Stones with Hydration (PUSH) randomized clinical trial (NCT03244189) published in The Lancet.¹ Despite modest improvements in urine volume, recurrence rates remained similar between groups over 2 years of follow-up. For clinicians, the results highlight the persistent gap between physiologic targets and real-world adherence, as well as the complexity of secondary prevention in stone disease.

Why Are So Many Young Teens Getting Kidney Stones?

Researchers are trying to figure out why a growing number of teens are getting kidney stones. One factor all doctors seem to agree on is that today’s teens aren’t drinking enough water. The PUSH study is using a combination of technology, incentives, and coaching to get patients to drink more and possibly prevent getting stones again.

Kidney Stones Rising among Millennials

A new study by the Mayo Clinic, which reviewed about 30 years’ worth of data from a Minnesota county, has found that the incidence of kidney stones is on the rise, especially among women in the age range of 18 to 39. The PUSH study is looking at whether increased hydration can be used to decrease kidney stones.

Why Are More Kids Suffering From Kidney Stones?

Doctors say more kids than ever before are experiencing kidney stones, and drinking more water can help prevent them. The PUSH study is testing the best methods to encourage children and adults to drink water to reduce the recurrence of kidney stones.

As Kidney Stones Increase, Researchers Turn to Technology for Answers

Newly published research shows that kidney stones doubled in men and quadrupled in women between 1984 and 2012. As experts scramble for answers on how to quell this unwelcome spike, researchers with the PUSH study have been testing their own hypothesis for several months; namely, that a high-tech water bottle might be one key to reducing the recurrence of the urinary stone disease, commonly referred to as kidney stones.