Metabolic Workup of Stones
Helena Chang, MD, delves into the medical management of kidney stones, highlighting current guidelines, challenges, and future directions.
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Topic: Kidney Stones
Management of Urolithiasis During Pregnancy
Amy E. Krambeck, MD, explores the management of urolithiasis in pregnancy, emphasizing the challenges of diagnosis and treatment.
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6 o’clock Single-use Digital Flexible Ureteroscope
Sung Youg Cho, MD, MS, PhD, explores single-use digital flexible ureteroscopes for endoscopic stone surgery.
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Medications for Stone Disease
Amy E. Krambeck, MD, discusses the metabolic management of kidney stones and provides a comprehensive overview of pharmacologic treatments.
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Office-Based Removal Of Small Stones Ultrasonic Propulsion & Burst Wave Lithotripsy New Technologies In Endourology
Helena Chang, MD, explores noninvasive technologies for managing kidney stones, including ultrasonic propulsion and burst wave lithotripsy.
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PCNL Challenges: How to Keep the Train on the Rails
Wesley A. Mayer, MD, offers a comprehensive discussion on optimizing percutaneous nephrolithotomy (PCNL), focusing on minimizing complications, strategic planning, and adaptive surgical techniques.
In this 20-minute presentation, Dr. Mayer reviews indications for PCNL with updates on guidelines. He stresses the importance of individualized treatment decisions. Mini PCNL is emphasized for challenging lower pole stones, and for smaller stones, balancing efficiency and patient outcomes.
Dr. Mayer stresses preoperative preparation, underscoring the value of detailed imaging. The choice of access (prone vs. supine) is tailored based on patient anatomy, stone location, and procedural requirements. The importance of a flexible and adaptive approach is stressed, with practical examples illustrating the decision-making process when encountering complications.
Lastly, Dr. Mayer underscores the importance of knowing when to continue versus when to safely abort a procedure, reflecting on the need for prudent judgment to optimize patient safety and surgical outcomes.
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Innovative Office-based Kidney Stone Treatment
Mathew Sorensen, MD, MS, FACS, Associate Professor of Urology at the University of Washington in Seattle, examines advances in non-invasive treatments for kidney stones, highlighting two key technologies poised to shift clinical practice. In this 21-minute presentation, he discusses ultrasonic propulsion and then transitions to a second innovation, burst wave lithotripsy. Clinical studies on these technologies indicate a shift toward managing smaller stones and residual fragments more proactively, potentially avoiding more invasive interventions.
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The Value of Making Your Patient Stone Free
Mathew Sorensen, MD, MS, FACS, examines the management of asymptomatic small kidney stones, particularly when discovered incidentally during imaging or when patients undergo surgery for a primary stone. There is a noted clinical debate on whether these additional, often small, stones warrant treatment.
In this 14-minute talk, Dr. Sorensen highlights that residual fragments frequently persist after lithotripsy, posing potential risks, including emergency visits or further surgeries. A multicenter randomized clinical trial, published in the New England Journal of Medicine, sought to clarify this issue. The results show a significantly lower relapse rate (16%) in the treatment group compared to the control group (63%)suggesting a substantial benefit in reducing future stone-related events. The study underscores the evolving approach in urology towards more proactive treatment of small stones, facilitated by less invasive technologies.
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Stone Volume is a Better Predictor of Spontaneous Stone Passage
Dr. Seth K. Bechis, MD, discusses the critical role of stone volume as a predictor of spontaneous stone passage in patients with urolithiasis. He emphasizes that while stone size has traditionally been considered the primary factor in determining the likelihood of spontaneous passage, emerging evidence suggests that stone volume offers a more accurate assessment. Dr. Bechis advocates for integrating this assessment into routine evaluation protocols.
In this 16-minute presentation, Dr. Bechis explains that stone volume, which accounts for both the size and the three-dimensional shape of the stone, provides a more comprehensive measure that correlates better with clinical outcomes. This is especially relevant in determining whether to pursue active intervention or adopt a more conservative, observational approach.
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Panel Discussion: MIS, Renal Stones, and Transplants
Richard E. Link, MD, PhD; Wesley A. Mayer, MD
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Controversies in Percutaneous Nephrolithotomy
Manoj J. Monga, MD, FACS examines the indications for PCNL, emphasizing the criteria that influence the decision to opt for this invasive treatment. He highlights differing opinions on patient selection and the importance of individualized treatment plans.
Dr. Monga focuses on the technical aspects of PCNL and various approaches and techniques. He reviews the debate over the optimal access points, upper pole versus lower pole entry, and the risks and benefits of miniaturized versus standard tracts. He analyzes outcomes related to stone clearance rates, complications, and recovery times. Dr. Monga further explores the controversies in postoperative management, particularly the use of nephrostomy tubes versus tubeless procedures.
Emerging technologies and innovations in PCNL are also a key part of this presentation. Advancements in imaging techniques, new instruments, and their potential to enhance the safety and effectiveness of the procedure are examined, as well as the need for ongoing research.
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Asymptomatic Stones: Remove Each Piece? Or Leave in Peace?
Benjamin K. Canales, MD, MPH discusses the prevalence and natural history of asymptomatic kidney stones, emphasizing that while these stones may not initially cause symptoms, they have the potential to lead to significant complications, including pain, infection, and obstruction. He identifies various factors that influence the decision-making process, such as stone size, location, composition, and patient-specific factors including age, comorbidities, and risk of future stone-related events.
Dr. Canales discusses the current guidelines and evidence-based practices for managing asymptomatic stones, including the benefits and risks associated with both intervention and observation. He highlights the criteria for selecting patients who may benefit from proactive treatment, such as those with high-risk anatomical features or a history of recurrent stones, and scenarios where a conservative approach, involving regular monitoring and preventive measures, may be more appropriate.
Technological advancements and surgical techniques have improved the safety and efficacy of stone removal procedures. Dr. Canales reviews minimally invasive options, such as ureteroscopy and percutaneous nephrolithotomy, and their role in the management of asymptomatic stones. The presentation includes a discussion on the potential complications of these procedures and the importance of patient counseling to set realistic expectations.
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