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Instructional Course

Instructional Course - Available with the Platinum and Silver packages or Individual Course Ticket

027IC - Adaptive PCNL: Utilizing a Contemporary Toolbox

Saturday, May 14, 2022

7:30 AM – 9:30 AM

Location: Room 210

Instructional Course Director(s)

Nishant D. Patel, MD

MD
University of Virginia Health System

Instructional Course Faculty(s)

Ryan S. Hsi, MD,FACS

Vanderbilt University Medical Center
Karen L. Stern, MD

Associate Professor of Urology
Mayo Clinic Arizona
David T. Tzou, MD

Assistant Professor
Rajat Kumar Jain, MD

Assistant Professor
University of Rochester Medical Center

Learning Objectives:

Review proper padding, bolsters, leg supports, anesthetic concerns and feasibility of endoscopic-combined intrarenal surgery for supine and prone positions.
Discuss the impact of patient body habitus, kidney position, physician experience/comfort and instrument availability on deciding the most appropriate method of access.
Examine stone characteristics, risk of bleeding, torque, specialized dilation instruments, methods of stone removal (vacuum cleaner effect, etc.) with standardized and miniature tracts.
Discuss situations appropriate for laser lithotripsy during PCNL (miniature vs standardized) and review currently available lithotrites.
Identify situations were fragmenting versus dusting is more appropriate if laser lithotripsy is utilized during PCNL.

As many new techniques are now available to urologists performing percutaneous nephrolithotomy (PCNL), confusion can often arise as to which approach is appropriate for a particular clinical situation. Our video case-based and didactic discussions aim to guide urologists and endourologists to choose appropriate patient positioning method of access, size of tract and methods of stone removal for different PCNL clinical scenarios.

Participants will be able to identify patients suitable for
- Supine versus Prone Positioning
- Fluoroscopic versus Ultrasound versus Endoscopic versus IR access
- Miniature versus Standard Tract Size
- Laser lithotripsy versus lithotrite stone removal
- Dusting versus Fragmenting if Laser Utilized

The evidence on stone-free rates, complications rates, specific challenges, and retreatments rates will also be discussed. We will focus on standard techniques for index patients as well as special tips and tricks for more complex cases.