Headshot of Ben Chew, MD

Access through Obstructed Ureters

Dr. Chew discusses the importance of patience and strategic device selection to gain access through a ureter obstructed by a stone. The specific maneuvers required and different types of catheters and wires necessary for performing these difficult cases are highlighted.


Headshot of Ben Chew, MD

Four Techniques for Placing a Ureteral Stent

Dr. Chew discusses several patient presentations, including a ureteric or a UPJ obstruction, a tortuous ureter, and a drooping kidney, for which it may be challenging to place a stent. Dr. Chew demonstrates four different techniques to successfully place and position the stent depending on the situation. He offers advantages, watch-outs, clinical considerations and describes the specific steps of each approach.


Headshot of Igor Sorokin, MD

Hypercalciuria

Dr. 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. He points out what abnormalities to look for on the 24-hour urine test and interprets the lab results of each patient’s sample. He also discusses both dietary adjustments and pharmacological management techniques to reduce stone recurrence risk for each patient.


Headshot of Oliver Wiseman, MB BChir, MA, FRCS

Imaging for challenging cases and options for treatment

Dr. 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.


Headshot of Khurshid Ghani, MBChB, MS, FRCS

Managing Patients with Cystinuria

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.


Headshot of Michael Palese, MD

Management of Transplant Nephrolithiasis

Dr. Palese and Dr. Small explain the specific risk factors, unique anatomical intricacies, and technical considerations for stone removal in a transplanted kidney. The case of a 68-year-old male with end stage renal disease who presents with stones 11 months post kidney transplant is shared. Drs. Palese and Small explain the required and careful thought process to ensure the best possible outcome of this and similar transplant cases, all of which are deemed highly complex. Drs. Palese and Small also address how to treat donor-gifted lithiasis prior to implantation.


Headshot of Amy Krambeck, MD

Percutaneous Diverticulum (Perc-Tic) Renal Access Technique

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. The patient was referred to her after undergoing a previous percutaneous stone removal in which, despite multiple percutaneous accesses into the kidney, the referring urologist was unable to advance a wire into the standard collecting system and down the ureter. Dr. Krambeck discusses the importance and benefits of utilizing the Perc-Tic technique, a percutaneous diverticulum access technique for this type of situation. She provides information on the devices and a step-by-step process to the technique required to circumvent the obstruction, remove the stone, and find/reopen the connection to the collecting system.


Headshot of Oliver Wiseman, MB BChir, MA, FRCS

Reconstruction Cases: Antegrade and Retrograde URS - Part 1

Part 1: In the first installment of a two-part series on managing patients who have had a reconstruction, Mr. Wiseman talks about a strategy for gaining access in patients when a retrograde approach is unsuccessful. He presents his approach to gaining antegrade access in a 60-year-old male with bilateral upper ureteric stones who previously had a cystoprostatectomy and urethrectomy, as well as a key recommendation around post-operative imaging in these types of patients.


Headshot of Oliver Wiseman, MB BChir, MA, FRCS

Reconstruction Cases: Antegrade and Retrograde URS - Part 2

Part 2: In the second installment of the series on managing patients who have had a reconstruction, Mr. Wiseman discusses his approach to gaining retrograde access to treat a lower pole stone in a 45-year-old female with a transplant kidney. The patient had been referred to him after an unsuccessful stent insertion.


Headshot of Adam G Kaplan, MD.

Robotic Surgery in Urology

Dr. Kaplan discusses the advantages of robotic surgery in urology, and presents a hard-to-reach complex stone location for which a robotic approach is warranted. He describes the step-by-step technique to perform a robotic-assisted nephrolithotomy and calyceal diverticulectomy in a 65-year-old patient with a 2.4 cm right renal stone.


Headshot of Raymond Ko, MD

Retrograde IntraRenal Surgery (RIRS) Using a Flexible Ureteroscope Combined with 16F MINI-PCNL

Dr. Ko performs an endoscopic combined intrarenal surgery (ECIRS) in prone PCNL position to treat a 70-year-old patient with challenging anatomy and a large volume of stones in his left kidney. He combines this technique with the bull’s-eye approach to provide accurate access into the collecting system. Dr. Ko discusses the unique challenges of the patient’s anatomy and his step-by-step approach to gain access, in the safest possible way without causing complications, through stent placement. He also shares his view of the advantages of a mini percutaneous nephrolithotomy using a 16.5 French metal sheath and the LithoVue™ Single-Use Digital Flexible Ureteroscope to treat large stone bulk.


Headshot of Daniel Wollin, MD.

Treating a Large Stone Diverticulum in a Patient with a Duplicated Collecting System

In this case study, a 58-year-old female presented with a 2.2 cm 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.


Headshot of Stephen Nakada, MD

Treating Stones in Patients with Horseshoe Kidneys

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.


Headshot of Ioannis Kartalas Goumas, MD

Treatment of Urinary Stones in Patients with Spinal Deformities

Kidney stone patients with skeletal deformities typically present with a variety of procedural challenges. Because the anatomy of these patients is atypical, they frequently are associated with comorbidities such as hip ankylosis or a shifting kidney as common examples. This can make it challenging for the surgeon to position the patient in the lithotomy position and gain access to the kidney.


Headshot of Julio G. Davalos, MD

Ureteroscopy for a Large Lower Pole Stone and Narrow Infundibulum

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.


Headshot of Timothy Large, MD

Urine Alkalinization for Kidney Stones

Dr. 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.


Headshot of Nicole Miller, MD.

Using an Access Sheath in a Patient with Medullary Sponge Kidney Disease

A 46-year-old patient with a history of recurrent urinary tract infections and pyelonephritis presented with medullary sponge kidney disease. Dr. 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.


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