This case examines how Dr. Ghani used a laser lithotripsy dusting approach to treat a 55-year-old patient with multiple stones and gross hematuria with the goal of completing the procedure without leaving a stent. He covers pre-operative planning, stone positioning, fiber and dynamic laser setting selection, and both contact and non-contact strategies. He also discusses the keys to a successful dusting procedure, and his decision-making criteria regarding the need for stent placement.
Dr. Sur discusses the procedural challenges of removing a complete staghorn renal calculus from a middle-aged morbidly obese man. He describes the patient’s complications during a PCNL, why the procedure was abandoned, and how multiple ureteroscopy (URS) procedures using a dusting technique led to a successful outcome. Dr. Sur also highlights the importance of patient communication and establishing realistic expectations early.
Dr. Jaffe discusses flexible ureteroscope maneuvers that enable access into difficult-to-reach parts of the kidney. He highlights enabling direct visualization, laser lithotripsy and basket retrieval in patients with stenosis and stones in hard-to-reach angles and areas within the collecting system.
An impacted ureteral calculus is a common and difficult situation for a urologist. Dr. Abbott discusses considerations aimed at decreasing complications and improving outcomes when removing an impacted stone. He shares his techniques and technology used for this procedural challenge.
A 46-year-old patient with a history of recurrent urinary tract infections and pyelonephritis presented with medullary sponge kidney disease. Dr. Nicole Miller summarizes the complexities of the case and discusses why a staged ureteroscopy was her preferred operative technique. She discusses the benefits of using a ureteral access sheath to atraumatically access the kidney repeatedly, why using an access sheath was invaluable to this particular case, and her general selection process when choosing a ureteral access sheath.
Dr. Keng-Siang Png describes his approach to treating large, greater than 2 cm, proximal ureteral stones. He discusses the importance of patient individualization to determine when to utilize PCNL, ureteroscopy or ureterolithotomy using a laparoscopic technique. He presents one patient case with an impacted 3 cm upper ureteral stone, with additional large lower pole stones, where he elected to perform a ureterolithotomy.
Because stone patients are exposed to radiation recurrently throughout their lives, learning how to manage radiation is very important. Dr. Lipkin describes a variety of tips and techniques with specific examples to manage radiation in the OR.
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. Cho discusses his surgical technique for maximizing the efficiency of laser lithotripsy stone dusting procedures, including irrigation tips and ways to optimize visibility of the surgical field and efficiently evacuate dust.
Dr. Giusti describes a simultaneous bilateral surgery involving two surgeons operating in tandem to complete a case within a single procedure. Dr. Giusti performed a percutaneous operation on multiple >1 cm left kidney stones, and at the same time, Dr. Proietti performed flexible ureteroscopy to address the patient’s 1.5 cm right kidney stone. Dr. Giusti details his step-by-step technique and the devices used to successfully complete the procedure.