Topic: Kidney Stones

PCNL Challenges: How to Keep the Train on the Rails

PCNL Challenges: How to Keep the Train on the Rails

by | Jan 2025

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

Innovative Office-based Kidney Stone Treatment

by | Nov 2024

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

The Value of Making Your Patient Stone Free

by | Oct 2024

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

Stone Volume is a Better Predictor of Spontaneous Stone Passage

by | Oct 2024

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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