Evolving evidence, evolving guidelines
AUA2026 showcased guideline updates designed to support patient-centered, evidence-based care.
AUA2026 featured several important guideline updates and discussions, offering clinicians new perspectives on patient-centered care, evolving technologies and evidence-based decision-making. Here are some of the highlights.
Clarifying antibiotic use in stone surgery
Updated guidance on the surgical management of kidney and ureteral stones provides clearer recommendations on when prophylactic antibiotics are necessary—and when they can safely be avoided. Speakers emphasized the importance of preoperative urine testing and culture-directed therapy for patients with positive cultures, while noting that prophylactic antibiotics may be omitted before shock wave lithotripsy because of the procedure's low risk of postoperative infection. The recommendations aim to reduce unnecessary antibiotic use while maintaining patient safety.
“There are a couple of very important AUA guidelines that pertain to [suspected infection]. First, positive bacterial and fungal cultures should be treated prior to definitive stone surgery,” said Vincent Bird, MD, professor at the University of Florida College of Medicine. “Some other important aspects of these guidelines include getting labs, complete blood count (CBC), basic metabolic panel (BMP), urinalysis and urine culture. The important factors here are urine culture for identification of infectious organisms and BMP to assess renal function and extent of infection.”
Advancing patient-centered stone care
Revised guidelines for the surgical management of kidney and ureteral stones place greater emphasis on quality of life, shared decision-making and individualized treatment selection. New recommendations address topics ranging from mini-PCNL and flexible and navigable suction sheaths to the use of low-dose aspirin before surgery. The updated guidance also incorporates evolving evidence for adult, pediatric and pregnant patients, helping clinicians balance treatment effectiveness with patient goals and preferences.
“The guideline consists of 60 statements that encompass the treatment evaluation of kidney and ureteral stones in both adult and pediatric patients, as well as the treatment of pregnant patients,” said Margaret S. Pearle, MD, PhD, guideline panel co-chair. “Five are classified as strong recommendations, nine are classified as moderate recommendations and 29 are conditional recommendations, in which there's a balance between the benefit and risk of a particular action.”
Updated BPH guidance reflects evolving therapies
New recommendations for benign prostatic hyperplasia (BPH) reinforce a patient-centered approach while incorporating emerging evidence and new treatment options. The guidelines continue to emphasize shared decision-making and individualized care, while recognizing newer medical and procedural therapies, including combinations that may help preserve ejaculatory function. Legacy technologies have been retired, while newer minimally invasive approaches continue to reshape the treatment landscape.
"This is a patient-centered guideline with shared decision-making from the center," said Jaspreet S. Sandhu, MD, attending urologist at the Memorial Sloan Kettering Cancer Center in New York City.
