Ryan Hsi, MD, FACS

Associate Professor
Department of Urology
Division of Endourology and Stone Disease

Medical School: Loma Linda University, School of Medicine
Residency: University of Washington, School of Medicine
Fellowship: University of California, San Francisco
Clinical Interests: Endourology, Kidney Stones

Dr. Hsi is an expert in the medical and surgical management of kidney stone disease and co-leads the complex kidney stone clinic.  He leads an active research team and is actively recruiting for several clinical trials.

Positions and Employment

2009-2010     Resident in General Surgery, University of Washington Medical Center
2010-2015     Resident in Urology, University of Washington Medical Center
2015-2016     Laparoscopy & Endourology Fellow at the University of California, San Francisco
2016-2021     Assistant Professor, Department of Urology, Vanderbilt University Medical Center
2021-             Associate Professor, Department of Urology, Vanderbilt University School of Medicine

Honors and Awards

2023-24              AUA Leadership Program, Southeast Section Representative
2022                   Excellence in Patient Experience, Vanderbilt University Medical Center, ≥90th   percentile nationally in patient experience for fiscal year 2022
2022                    Urology Practice Journal Top Reviewer (Vol 9, Issue 6, Nov 2022)
2022 Nominee, Patient and Family Choice Award, Vanderbilt University Medical Center
2021 Excellence in Patient Experience, Vanderbilt University Medical Center, ≥90th percentile nationally in patient experience for fiscal year 2021
2018                American Urological Association/Japanese Urological Association Academic Exchange Scholar
2017                Best Reviewer Award, Engineering & Urology Society, AUA Annual Meeting, Boston
2015                Resident as Teacher Award
2015                In-Service Award
2014                1st Place Presentation, J. Tate Mason Award, Northwest Urological Society
2013                Warren H. Chapman Resident Research Award
2013                Best Poster of Session, Imaging/Radiology, AUA Annual Meeting, San Diego
2013                Best Poster of Session, Sexual Function/Dysfunction/Andrology, AUA Annual Meeting, San Diego
2013                Best Abstract. Connors et al. AUA Annual Meeting 2013
2013                NIH Trainee Travel Award, American Society of Andrology, San Antonio TX
2012                1st Place Presentation, J. Tate Mason Award, Northwest Urological Society
2012                Best Poster, International Kidney Stone Institute Stone Meeting, Indianapolis, IN
2012                IVUmed Traveling Resident Scholarship, Ghana, January 2013
2012                Engineering & Urology Society (EUS) Best Paper Award
2011, 2012      Western Section AUA Annual Meeting Scholarship 2011, 2012 
2011                Hirschler Fellowship Award, Department of Urology, University of Washington
2011                Best Poster of Session, Stone Disease, AUA Annual Meeting. Washington D.C. 
2008                Alpha Omega Alpha (AOA), Loma Linda University School of Medicine
2008                First Place, Scientific Poster Session, Annual Postgraduate Convention, Loma Linda
2008                Walter E. Macpherson Society Student-Faculty Research Award, Loma Linda 
2006                Walter E. Macpherson Society Summer Research Scholarship, Loma Linda

Other Experience and Professional Memberships

American Urological Association
Southeastern Section of the American Urological Association
Endourological Society
Vanderbilt Urology Society
American Medical Association
American College of Surgeons, Fellow
Research on Calculus Kinetics (R.O.C.K.) Society
Collaborative for Research in Endourology (CoRE)
Endourology Disease Group for Excellence (EDGE)

Contribution to Science

Phenotyping and genotyping within electronic health records (EHRs).

We have reported our phenotyping method for kidney stone disease within the EHR and report high fidelity method for kidney stone identification from unstructured clinical notes (PMID: 31310771). This impact of this work is that it enables large-scale disease association studies within the EHR framework. We further performed GWAS by kidney stone diagnosis and multiple GWAS separately by individual kidney stone compositions. Our finding showing the UMOD gene associating with disease replicates previous GWAS findings. We also discover novel associations by kidney stone composition. In addition, we perform deep phenotyping through extraction of 24-hour urine data, and we applied this towards stone composition prediction using a machine learning framework (PMID: 34314237).  Finally, within the All of Us research database, we identify and describe kidney stone prevalence based on diagnosis codes from the EHR and compare them to self-reported kidney stone prevalence.  We found that self-reported prevalence was higher than EHR-based prevalence, and that one in four individuals with kidney stone disease have ongoing medical treatment.

  1. Bejan CA, Lee DJ, Xu Y, Hsi RS. “Performance of a Natural Language Processing Method to Extract Stone Composition From the Electronic Medical Record.” Urology, 2019 Oct;132:56-62. PMID: 31310771.
  2. Hsi R, Zhang S, Xu Y, Bejan C. “A Genome-Wide Association Study of Nephrolithiasis Identified from Electronic Health Records.” Journal of Urology 2021; 206(S3).
  3. Abraham A, Kavoussi N, Sui W, Bejan C, Capra JA, Hsi R. “Machine Learning Prediction of Kidney Stone Composition Using Electronic Health Record-Derived Features.” J Endourol. 2022 Feb;36(2):243-250. PMID: 34314237.
  4. Forbes CM, Nimmagadda N, Kavoussi N, Xu Y, Bejan CA, Miller NL, Hsi RS. “Kidney stone prevalence based on self-report and Electronic Health Records: insight into the prevalence of active medical care for kidney stones.” medRxiv 2022.05.17/22275212.

Disease association studies and risk within electronic health records (EHRs)

Through our phenotyping work, we then have examined relationship of urinary phenotypes with chronic kidney disease (CKD) (PMID: 32578450). We show that higher CKD stage is associated with most but not all urinary stone risk parameters. We also have examined the relationship of kidney stone disease with adverse coronary events (PMID:31697954). We show that kidney stone history is associated with higher risk of mortality after percutaneous coronary intervention. Since the EHR has detailed medication history and usage, we examined the role of proton pump inhibitors and risk of incident kidney stone disease (PMID 35499617). We show that use of these medication is associated with stone risk, and that this appears to be mediated by adverse changes in urinary citrate and magnesium.

  1. Sui W, Calvert JK, Kavoussi NL, Gould ER, Miller NL, Bejan CA, Hsi RS. “Association of Chronic Kidney Disease Stage with 24-Hour Urine Values Among Patients with Nephrolithiasis.” J Endourol. 2020 Dec;34(12):1263-71. PMID: 32578450.
  2. Lai CH, Huang LC, Holby SN, Lai YJ, Su PF, Cheng YS, Shyr Y, Hsi RS. “Kidney Stone History and Adverse Outcomes After Percutaneous Coronary Intervention.” Urology, 202 Feb;136:75-81. PMID:31697954. PMID: 26239232 PMCID: PMC4677566
  3. Sui W, Miller NL, Gould ER, Zhang KC, Koyama T, Hsi RS. “Proton pump inhibitors use and risk of incident nephrolithiasis.” Urolithiasis, 2022 May 2. [Online ahead of print]. PMID: 35499617.

Epidemiology and pathophysiology of kidney stones

For over 50 years we have thought that the initiating event for idiopathic calcium stone disease is the Randall plaque, on which stones grow, break off, and become active urinary stones. Using advanced high-resolution microscopy, I described intratubular mineralization of the renal medullary tissue proximal to the Randall plaque (PMID: 27306864). These findings may focus the development of therapeutics that would help modulate or slow the mineralization process at the tissue level. These data are supported by epidemiologic work describing the associations of demographics, metabolic syndrome, diet, and vascular disease with kidney stone risk (PMIDs 29753847, 31430246, 26454103).

  1. Hsi RS, Ramaswamy K, Ho SP, Stoller ML. “The origins of urinary stone disease: upstream mineral formations initiate downstream Randall’s plaque.” BJU Int. 2017; 119(1):177-84. PMID: 27306864 PMCID: PMC5161725
  2. Hsi RS, Kabagambe EK, Shu X, Han X, Miller NL, Lipworth L. “Race- and Sex-related Differences in Nephrolithiasis Risk Among Blacks and Whites in the Southern Community Cohort Study.” Urology. 2018 Aug;118:36-42. PMID: 29753847
  3. c.    Shu X, Calvert JK, Cai H, Xiang YB, Li H, Zheng W, Shu XO, Hsi RS. “Plant and Animal Protein Intakes and Risk of Incident Kidney Stones: Results from the Shanghai Men’s and Women’s Health Studies.” J Urol. 2019 Dec;202(6):1217-1223 PMID: 31430246.
  4. Hsi RS, AJ Spieker, ML Stoller, DR Jacobs, AP Reiner, RL McClelland, AJ Kahn, T Chi, M Szklo, MD Sorensen. “Coronary artery calcium score and association with recurrent nephrolithiasis: the Multi-Ethnic Study of Atherosclerosis.” Journal of Urology. 2016; 195(4 Pt 1):971-6. PMID: 26454103 PMCID: PMC4966606

Utility of selective versus empiric therapy for kidney stone prevention

I have critically evaluated the role of 24-hour urine testing to identify urinary abnormalities to inform decision-making for prevention of kidney stone recurrence. I published a literature review on the stone clinic effect and 24-hour urine testing (PMID 27746283). Then we performed two observational studies on the impact of 24-hour urine testing and kidney stone recurrence outcomes (PMID 33352163, 32540303).  We showed that 24-hour urine testing in patients with a history of multiple stone events is beneficial among patients on medical preventative therapy.  As some patients are unable to have 24-hour urine testing, we compared the effectiveness of different preventative medication classes on stone recurrence among those without testing (PMID: 35545149). Through this work, I show that the 24-hour urine provides actionable data to inform selection of preventative therapies, and we show that when testing is not available, thiazide use is associated with the lowest risk of subsequent stone events.

  1. Hsi RS, Sanford T, Goldfarb DS, Stoller ML. “The role of the 24-hour urine collection in the prevention of kidney stone recurrence.” Journal of Urology. 2017 Apr;197(4):1084-1089. PMID: 27746283
  2. Hsi RS, Yan PL, Goldfarb DS, Egbuji A, Si Y, Shahinian V, Hollingsworth JM. “Comparison of Selective Versus Empiric Pharmacologic Preventative Therapy With Kidney Stone Recurrence.” Urology 2021 Mar;149:81-88. PMID: 33352163
  3. Hsi RS, Yan PL, Crivelli JJ, Goldfarb DS, Shahinian V, Hollingsworth JM. “Comparison of Selective vs Empiric Pharmacologic Preventive Therapy of Kidney Stone Recurrence with High-Risk Features.” Urology. 2022 Feb 17 [Online ahead of print]. PMID: 34536410.
  4. Hsi RS, Yan PL, Crivelli, JJ, Goldfarb DS, Shahinian V, Hollingsworth JM. “Comparison of empiric preventative pharmacologic therapies on stone recurrence among patients with kidney stone disease.” Urology. 2022 May 8 [Online ahead of print]. PMID: 35545149.

Comparative effectiveness of treatments for kidney stone disease

I have actively participated in several clinical studies for kidney stone disease.  We performed the first-in-human clinical study for ultrasound to reposition kidney stones in the urinary system (PMID: 26521719).  We performed a randomized controlled trial comparing an analgesic suppository to placebo for post-surgical pain after ureteroscopy (PMID: 27658661).  Then, we evaluated an opiate-free protocol after ureteroscopy for kidney stone treatment and show improved patient outcomes (PMID: 31928086). In addition, we performed a multi-center study evaluating antibiotic use prior to percutaneous nephrolithotomy (PMID: 33369488).

  1. Harper JD, Cunitz BW, Dunmire B, Lee FC, Sorensen MD, Hsi RS, Thiel J, Wessells H, Lingeman JE, Bailey MR. “First-in-human clinical trial of ultrasonic propulsion of kidney stones.” Journal of Urology. 2016 Apr;195(4P1):956-64. PMID: 26521719 PMCID: PMC4851928
  2. Sur RL, Krambeck AE, Large T, Bechis SK, Friedlander DF, Monga M, Hsi RS, Miller NL, Chew BH, Lange D, Knudsen B, Sourial MW, Humphreys MR, Stern KL, Shah O, Abbott JE, Abedi G. “A Randomized Controlled Trial of Pre-operative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in Moderate to High Risk Infectious Risk Population: A Report from the EDGE Consortium.” J Urol. 2021 May;205(5):1379-1386 PMID: 33369488.
  3. Lee FC, Holt SK, Hsi RS, Haynes B, Harper JD. “Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: a Randomized, Double-Blinded, Placebo Controlled Study.” Urology. 2017 Feb;100:27-32. PMID: 27658661 PMCID: PMC5448974
  4. Gridley C, Robles J, Calvert J, Kavoussi N, Winkler T, Jayaram J, Fosnot M, Liberman J, Allen B, McEvoy M, Herrell D, Hsi R, Miller NL. “Enhanced Recovery After Surgery Protocol for Patients Undergoing Ureteroscopy: Prospective Evaluation of an Opioid-Free Protocol.” J Endourol 2020 June;34(6):647-653. PMID: 31928086.

Ultrasonography for kidney stones

I have worked on several projects to improve ultrasound performance for kidney stone imaging.  We have developed several advanced beamforming methods specific for kidney stones.  In addition to studying B-mode adjuncts such as the color Doppler twinkling and stone shadow for improving stone detection, I have studied methods to improve stone sizing. I have worked collaboratively with ultrasound engineers to perform in vitro experiments, and when the algorithms were optimized, I recruited human stone formers for in vivo testing. Several important clinically relevant ultrasound techniques were developed from this work, including utilizing the stone shadow in improve detection specificity and stone sizing. We have also demonstrated that the presence of twinkling improves detection specificity.

  1. Hsi RS, Schlunk SG, Tierney JE, Dei K, Jones R, George M, Karve, P, Duddu R, Byram BC. “Feasibility of non-linear beamforming ultrasound methods to characterize and size kidney stones.” PLoS One Aug 28;13(8:e0203138. PMID: 30153279.
  2. Tierney JE, Schlunk SG, Jones R, George M, Karve P, Duddu R, Byram BC, Hsi RS. “Next-generation ultrasound methods for kidney stone characterization: Feasibility of non-linear beamforming techniques.” Urolithiasis 2019 Apr;47(2):181-8. PMID: 29356874.
  3. Dunmire B, Lee FC, Hsi RS, Cunitz BW, Paun M, Bailey MR, Sorensen MD, Harper JD. “Tools to improve the accuracy of kidney stone sizing with ultrasound.” Journal of Endourology. 2015 Feb;29(2):147-52. PMID: 25105243 PMCID: PMC4313404
  4. Sorensen MD, Harper JD, Hsi RS, Shah AR, Dighe MK, Carter SJ, Moshiri M, Paun M, Lu W, Bailey MR. B-mode Ultrasound Versus Color Doppler Twinkling Artifact in Detecting Kidney Stones.  Journal of Endourology. 2013 Feb;27(2):149-53. PMID: 23067207 PMCID: PMC3573723

Complete List of Published Work in MyBibliography

Active Clinical Trials

Empiric Versus Selective Prevention Strategies for Kidney Stone Disease

The aims of this study are to conduct a clinical trial comparing two major strategies for kidney stone prevention.

Learn more about this study.

PI: Ryan Hsi, MD

Ureteral Stent Trial

Ureteral Stent Placement After Ureteroscopy for Renal Stones: A Randomized Controlled Trial. The rationale for this study is to determine if there is a difference in complications among patients undergoing ureteroscopy for renal stones who receive a stent compared to not receiving a stent postoperatively.

Learn more about this trial

PI: Ryan Hsi, MD

Kidney Stone Pain (ENORC)

Evaluation of Pain Before and After Removal of Non-obstructive Kidney Stones (ENORC).  The objective of this study is to prospectively determine if the removal of non-obstructing renal calculi can reduce or eliminate participant's pain and/or improve their quality of life.

Learn more about this trial

PI: Ryan Hsi, MD