Headshot of Philip T. Zhao, MD

Balloon Dilation for Management of Large Distal Ureteral Stones

Dr. Zhao describes a technique utilizing balloon dilation to remove distal ureteral stones intact or with minimal laser lithotripsy. Dr. Zhao highlights the use of this technique in a 61-year-old male with two stones at different locations within the right ureter. First, a 7 mm stone near the UVJ that he was able to remove completely intact, and then farther up the ureter a 13 mm stone at the iliac vessel that was broken into a couple of fragments for extraction. Dr. Zhao discusses the steps, tools and guidelines to utilizing this efficient stone extraction technique to complete the case.


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 Chong Tsung Wen, MD

Managing a Retained Stent with Impacted Upper Ureteric Stones - The limits of RIRS

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.


Headshot of Marshall Stoller, MD

Managing Encrusted Double J Stents and Other Challenging Ureteroscopic Cases

Dr. Stoller discusses the surgical challenges of removing a highly encrusted stent, including setting expectations with patients. He also covers selecting a strategy and stone clearance objective for various potential approaches and ensuring the most appropriate equipment is available to treat the patient in a productive fashion.


Headshot of Keng-Siang Png, FRCS

Management of Large Proximal Ureteral Stones

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.


Headshot of Marshall Stoller, MD

StoneSmart Live: Managing Encrusted Double J Stents and other Challenging Ureteroscopic Cases

Discussing Managing Encrusted Double J Stents and other Challenging Ureteroscopic Cases with Marshall Stoller, MD.


Headshot of Roger Sur, MD

StoneSmart Live: Treating Staghorn Stones Ureteroscopically

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.


Headshot of Roger Sur, MD

Treating Staghorn Stones Ureteroscopically

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.


Headshot of Andrew J. Portis, MD

Ureteral Access Sheath Algorithm for Efficient Stone Extraction

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.


Headshot of Jamison S. Jaffee, DO, FACOS

Using a Single-Use Scope for Lower Pole Access

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.


Headshot of Justin B. Ziemba, MD

What Makes an Effective Stone Practice

Dr. Ziemba describes managing a patient from their initial office visit through treatment, including longitudinal follow-up with the goal of preventing recurrent stones. He discusses implementing processes and building an infrastructure for a practice, clinic or hospital that are specifically designed to support a successful kidney stone practice. Dr. Ziemba discusses how he plans for patient access; office counseling; expectation management; and peri-operative, post-operative and stone prevention management. He provides an example patient case that highlights the practices, templates and tools his team utilizes through each phase of care.


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