Journal club: The use of antibiotic prophylaxis for ESWL treatment of urolithiasis (APPEAL trial)

In this Journal Club edition of the EAU Podcast, Prof. Thomas Tailly leads a focused discussion on the recently completed APPEAL trial, a multicentre randomised controlled study evaluating whether routine antibiotic prophylaxis is necessary for patients undergoing extracorporeal shock wave lithotripsy (ESWL).The distinguished panel - Prof. Kari Tikkinen, Prof. Zafer Tandogdu, Dr. Daron Smith, and Dr. Guido Kamphuis - explores the study’s design, recruitment challenges, outcome measures and the rationale behind examining antibiotic use in a procedure historically considered low-risk for infection.They discuss variations in practice across centres, the balance between preventing rare infectious complications and avoiding unnecessary antibiotic exposure, and how the trial contributes valuable evidence in an area with limited high-quality data.Throughout the episode, the panel reflects on how these findings align with current EAU recommendations and considers how the APPEAL trial can support future refinements in guideline statements. With a mix of expert insight, clinical reasoning and constructive debate, this episode offers listeners a clear understanding of the trial’s significance and its potential impact on everyday urological practice.You can find the article to the APPEAL trial here. For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.