Miss Thomas and Mr. Bultitude describe their approach to caring for patients with cystinuria. They discuss caring for these patients holistically, which includes not only surgical aspects but also monitoring and treating the patient’s lifelong stone disease. Pathology, diagnosis and principals of surgical approach to cystinuria stone formers are discussed. The physicians also present a complex cystine stone case in a 25-year-old patient that involves both percutaneous ultrasonic and ureteroscopic laser lithotripsy with retrieval approaches.
In this case study, a 68-year-old patient presented with a BMI of 29. A renal scan demonstrated a left renal function of 39% and a right renal function of 61%. A CT scan demonstrated a complete staghorn stone with multiple cysts in the parenchyma in the left kidney. Dr. Scoffone discusses ECIRS, a different stone removal approach personalized to the patient. He presents the surgical steps in ECIRS with pneumatic and ultrasonic combined lithotripsy.
Kidney stone patients with skeletal deformities typically present with a variety of procedural challenges. Because the anatomy of these patients is different, they are often associated with comorbidities such as hip ankylosis and a shifting kidney. This can make it challenging for the surgeon to position the patient in the lithotomy position and gain access to the kidney.
Dr. Fabio Vicentini describes a case of a 56-year-old male who was referred to him after experiencing right lumbar pain for three years. Two previous PCNL operations were unsuccessful due to challenging anatomy. A CT scan showed three large stones in a horseshoe kidney. Dr. Vicentini discusses his PCNL technique, device selection, approach to gaining access and patient positioning. Despite the challenging patient anatomy, the result was complete stone clearance.
This case study examines a 61-year-old female patient with recurrent kidney stone infections. The patient presented with a large calcium phosphate stone burden in the upper right pole. Dr. Shah shares his procedural techniques, including his laser lithotripsy strategy and preferred settings, to remove the large stone ureteroscopically.
Kidney stones are a common problem among adult patients with a horseshoe kidney, a congenital disease. Dr. Nakada presents the case of a 68-year-old male patient who has recurrent kidney stone infections and a horseshoe kidney. He discusses the epidemiology of a horseshoe kidney, how to navigate and treat kidney stones with an altered anatomy, and reviews the patient’s two different stone presentations, which included two different strategies of treatment.
In this case study, a 58-year-old female presented with a 2.2cm stone burden in the right upper pole calyceal diverticulum. She had no history of nephrolithiasis but was bothered by pain, gross hematuria, hypertension and diabetes. Dr. Wollin summarizes the intraoperative steps to safely gain and then maintain access and remove the stone. He also presents CT scans and intravenous pyelogram visuals of this infected complicated anatomy.
The role of ureteroscopy in stone removal has undergone a dramatic evolution over the years due to advancements in technology. Because of this, Dr. Davalos explains how and why he uses this less-invasive ureteroscopic approach to remove a dense calcium oxide monohydrate stone from the lower pole of a kidney. He describes the anatomical challenges of the patient, how he navigates through the procedure and the technology used.
Dr. Chong describes his approach to treating a patient who, prior to being referred to him, was in a hypercoagulable state, and even after three separate retrograde intrarenal procedures, the patient still had a large stone burden that remained in the kidney as well as steinstrasse in the ureter that prevented the stent from being removed. Unable to gain access to the proximal ureter from below, Dr. Chong explains his use of an antegrade approach to address the ureteral fragments.
Dr. Portis discusses his standardized decision-making algorithm to efficiently obtain secure ureteral access in a patient with severe recurrent stone disease presenting with a large ureteral obstructed stone and several renal stones. He explains his step-by-step approach to stone clearance, including both fragment clearance and intact extraction.