[VS-046]
Session: VIDEO SESSION 5 | Hall: MAIN HALL | Date: October 21, 2015 | Hour: 15:30 - 16:30Micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position
Andras HoznekINTRODUCTION:
Miniaturization of optical fibres and fragmentation tools allowed to progressively reducing the calibre of nephroscopes. In this film, we illustrate the technique of micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position.
MATERIAL-METHODS:
The technique is demonstrated with 4 diverse clinical cases. All patients were positioned in Galdakao modified supine Valdivia position. Puncture of collecting system was achieved under ultrasound and fluoroscopic guidance with the Polydiagnost “all seeing needle”. The stones were dusted using holmium laser via a 270 µm fibre and 0.8 Joule - 15 Hz settings. The energy was increased if necessary.
Patient history Stone characteristics Technique Drainage
# 1 64 year old male, failed ESWL, patient refused RIRS and double-J
15 mm stone in left kidney pelvis, 1.400 HU
Dusting with laser, no drainage
# 2 25 year old male, history of uretero-caliceal anastomosis in childhood, recurrent UTI, failed ESWL and RIRS
Two 8 mm stones in two different lower calix on left side
Two punctures, dusting, no drainage
# 3 45 year old female, residual stone after PCNL for staghorn, recurrent UTI, failed RIRS
8 mm lower pole of left kidney inaccessible with RIRS
Micro-ECIRS, dusting, no drainage
# 4 62 year old male, tetraplegic, ileal conduit, bilateral staghorn stone, recurrent UTI
Staghorn stone in left kidney
MiniPerc through lower calix, MicroPerc through mid-calyx, fragmentation with 500µm and 200µm fibre, stones removed with vacuum cleaner effet
Drainage: 8Ch nephrostomy
RESULTS: all procedures were successfuly completed without any complication
CONCLUSION: MicroPerc is an valuable method in specialized stone centers for specific indications. It can be proposed as an alternative of retrograde intrarenal surgery after informed consent of the patient, in specific anatomical configurations of the collecting system or as a supplement to flexible ureteroscopy or percutaneous nephrolithotomy. Microperc profitably completes the armamentarium of endourologic treatment modalities for stone disease.
Micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position
Andras HoznekINTRODUCTION:
Miniaturization of optical fibres and fragmentation tools allowed to progressively reducing the calibre of nephroscopes. In this film, we illustrate the technique of micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position.
MATERIAL-METHODS:
The technique is demonstrated with 4 diverse clinical cases. All patients were positioned in Galdakao modified supine Valdivia position. Puncture of collecting system was achieved under ultrasound and fluoroscopic guidance with the Polydiagnost “all seeing needle”. The stones were dusted using holmium laser via a 270 µm fibre and 0.8 Joule - 15 Hz settings. The energy was increased if necessary.
Patient history Stone characteristics Technique Drainage
# 1 64 year old male, failed ESWL, patient refused RIRS and double-J
15 mm stone in left kidney pelvis, 1.400 HU
Dusting with laser, no drainage
# 2 25 year old male, history of uretero-caliceal anastomosis in childhood, recurrent UTI, failed ESWL and RIRS
Two 8 mm stones in two different lower calix on left side
Two punctures, dusting, no drainage
# 3 45 year old female, residual stone after PCNL for staghorn, recurrent UTI, failed RIRS
8 mm lower pole of left kidney inaccessible with RIRS
Micro-ECIRS, dusting, no drainage
# 4 62 year old male, tetraplegic, ileal conduit, bilateral staghorn stone, recurrent UTI
Staghorn stone in left kidney
MiniPerc through lower calix, MicroPerc through mid-calyx, fragmentation with 500µm and 200µm fibre, stones removed with vacuum cleaner effet
Drainage: 8Ch nephrostomy
RESULTS: all procedures were successfuly completed without any complication
CONCLUSION: MicroPerc is an valuable method in specialized stone centers for specific indications. It can be proposed as an alternative of retrograde intrarenal surgery after informed consent of the patient, in specific anatomical configurations of the collecting system or as a supplement to flexible ureteroscopy or percutaneous nephrolithotomy. Microperc profitably completes the armamentarium of endourologic treatment modalities for stone disease.
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Micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position
Micro-percutaneous nephrolithotomy in Galdakao-modified supine Valdivia position