Category: Stones: PCNL

VS1-9 - Endoscopic combined intra renal surgery with disposable ureteroscope: Bilateral synchronous treatment

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Complete staghorn stones are always a challenging surgery, even more with concomitant stones in the contralateral ureter or renal pelvis. Endoscopic combined intrarrenal surgery it´s our standard treatment for this situation, using the flexible ureteroscopy for both sides.


Methods :

To reach a stone free status for both sides in a same procedure we use a flexible disposable ureteroscope (Lithovue, Boston Sci) and rigid and flexible-nephroscope. Two Holmium (Ho) lasers are required to work at the same time, in the same kidney or in different renal units. High power lasers are used for the nephroscopy and medium power for the disposable ureteroscope.


Results :

A 55 yeas old male patient with a complete left staghorn stone (6x4cm) and a 15x5 mm right distal ureteral stone was treated.

In Valdivia supine position, cystoscopy was performed with the patient under general anesthesia. An ureteropelvic occlusion ballon catheter 6 Fr / 75 cm /0.4ml is positioned.  Keeping supine position the percutaneous tract was established. Puncture of the inferior calix using fluoroscope with 0º - 90º degrees technique. Second puncture to improve the access to all  the kidney. Dilatation was achieved using a 20ATM balloon dilatator to accommodate a 24 Fr sheath. A 18Fr nephroscope was inserted using a 1000 µm fiber Ho laser. We set the energy 5,5 J and 20 Hz. With high power laser we see fragments through the percutaneous access. Meanwhile flexible ureteroscopy (with another laser) help treating the ureteroplevic junction on the same kidney and later on clearing the stone in the contra lateral ureter.  We complete the extraction of the stones with a 4.5F Nitinol basket. A 18Fr nephrostomy tube and bilateral double J with a bladder catheter were left in place with minimal hematuria. The patient was discharged at 4rd day.


Conclusions :

Bilateral synchronous treatment it could be done safely for the patient and without damaging your armamentarium using a flexible disposable ureteroscope.

Oriol Angerri

Head of lithiasis department at Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
Fundacio Puigvert
BARCELONA, Catalonia, Spain

Head of the Urolithiasis Unit at the Urology Department in Fundació Puigvert, Barcelona.
Surgeon doing Supine PCNL, miniPCNL, RIRS, and laparoscopic approach for stone disease.
Involved in metabolic and cristalographic studies, control of urinary ph and all related factors to avoid stone recurrence. Special interest in cystinuric patients. Kidney trasplantation

Esteban Emiliani

Urologist
Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
Barcelona, Catalonia, Spain

Esteban Emiliani
Endourolgist at Fundacion Puigvert, Universidad Autonoma de Barcelona, Spain.
Special Interest & Research: Endourologic treatment of stone disease and upper urinary tract urothelial tumors. Lasers basic and clinical research.

EUSP fellowship programme from the European Association of Urology. Endourological Society fellowship:
- Tenon Hospital, endourology department, Univérsité Pierre et Marrie Curie, Paris 20, France. (Prof. Oliver Traxer) and MPUH, Nadiad, India (Prof. Mahesh Desai)



Lucía Mosquera

Urology resident at Fundació Puigvert, Barcelona
Barcelona, Catalonia, Spain

Francisco Sánchez

Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
Barcelona, Catalonia, Spain

Félix Millan

Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
Barcelona, Catalonia, Spain

Joan Palou

Chairman of Urology Departmentt at Fundacio Puigvert. Chair of the European School of Urology
Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
Barcelona, Catalonia, Spain