Headshot of Seth K. Bechis, MD

Obstructing 4 cm Proximal Ureteral Stone

Dr. Bechis discusses a percutaneous approach to treating a 52-year-old patient with a large 4 cm obstructed proximal ureteral stone. He highlights the steps and tools used to gain access to the proximal ureter. In addition, Dr. Bechis describes his technique and what to watch for when using a lithotripter, as well as the settings used to complete the case with a high stone-free success rate.


Headshot of Brian Eisner, MD

Prone vs. Supine Positioning for PCNL: Which is best? Part 1: Outcomes, Access and Positioning Technique

Part 1 of 2: Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique and patient positioning. In this two-part case study, Dr. Krambeck shares her perspective on why she prefers prone position while Dr. Eisner explains his preference toward the supine position. Part one covers access, positioning technique and patient outcomes. Part two addresses collaboration with the anesthesiologist, performing ECIRS and managing radiation.


Headshot of Amy Krambeck, MD

Prone vs. Supine Positioning for PCNL: Which is best? Part 2: Anesthesia, ECRIS and Radiation

Part 2 of 2: Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique and patient positioning. In this two-part case study, Dr. Krambeck shares her perspective on why she prefers prone position while Dr. Eisner explains his preference toward the supine position. Part one covers access, positioning technique and patient outcomes. Part two addresses collaboration with the anesthesiologist, performing ECIRS and managing radiation.


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 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 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 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 Fabio Vicentini, MD, PhD

Supine Positioning for PCNL on a Patient with a Horseshoe Kidney

Dr. 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.


Headshot of Jianxing Li, MD

Ultrasound-guided Renal Access for PCNL: Severe Spinal Deformity

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.


Headshot of Thomas Chi, MD

Ultrasound-guided Renal Access for PCNL – Clinical Considerations: Part I

Dr. 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.


Headshot of Thomas Chi, MD

Ultrasound-guided Renal Access for PCNL – Clinical Considerations: Part II

Dr. 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 clinical considerations to improving imaging and needle skills, and a method for overcoming the learning curve to utilizing ultrasound.


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