Dr. Timothy Large discusses the role of urine alkalinization in stone treatment, including as a way to reduce stone complexity, cost, morbidity and the burden of stone disease on a patient. Dr. Large shares the case of a 38-year-old female patient with comorbidities and a solitary kidney with a staghorn uric acid kidney stone compromising almost the entire renal pelvis. The patient also presented with challenges to her metabolic system for which Dr. Large discusses how a urine analysis was utilized and urine alkalinization was incorporated into post-operative treatment to reduce the risk of a reoccurring stone event.
Dr. Thomas Chi describes the key skills required to utilizing ultrasound-guided renal access for PCNL. He discusses the key elements to optimizing renal imaging and orienting yourself to anatomical landmarks, as well as needle control, including placement and puncture. Dr. Chi provides tips and tricks to improving imaging and needle skills, and method for overcome the learning curve to utilizing ultrasound.
Dr. Thomas Chi discusses the use of ultrasound-guided renal access for PCNL in two different case presentations – one patient in prone and another in supine position. For each patient position, Dr. Chi describes identification of important anatomical landmarks for image orientation and his technique for calyx targeting and stone identification. Dr. Chi closes with his method for utilizing ultrasound guided renal tract dilation.
Ultrasound guided access is the primary technique for PCNL in China and has been for over a decade. Dr. Li, who has conducted over 20,000 x-ray free PCNLs with his team since 2004, shares the case of a middle-aged male with bilateral staghorn stones and severe spinal deformity. Dr. Li explains how ultrasound guided PCNL access helped to mitigate potential injury for this particular case.
Dr. Oliver Wiseman discusses his use of detailed imaging techniques, including contrast CT and reconstructed models, in a 58-year-old patient with left loin pain and a duplex system. An initial non-contrast CT seemed to indicate a calcification in the interpolar area, yet no stone was found during the initial ureteroscopic intervention. Dr. Wiseman discusses how the use of more detailed imaging better equipped him to identify the location and size of a calyceal diverticulum. He also discusses how this imaging helped him to recognize a very narrow infundibula, which informed his treatment strategy and selection of the right intervention modality for this patient.
Dr. Chew discusses the importance of strategic device selection to gain access through a ureter obstructed by a stone. Highlights include specific maneuvers required and different types of catheters and wires necessary for performing these difficult cases.
Dr. Seth Bechis discusses a percutaneous approach to treating a 52-year-old patient with a large 4cm obstructed proximal ureteral stone.
Dr. Phil Zhao describes a technique utilizing balloon dilation to remove distal ureteral stones intact or with minimal laser lithotripsy.
Dr. Igor Sorokin describes his medical treatment goal for four patients presenting with clinical hypercalciuria: one with Medullary Sponge Disease, one taking Topamax, one with a solitary kidney and one with hyperparathyroidism.
Dr. Krambeck discusses a percutaneous nephrolithotomy procedure in a 54-year-old woman with a large upper pole stone completely obstructing the upper pole system.