EAU 2018: Endoscopic Combined Intrarenal Surgery with Disposable Ureteroscope: Bilateral Synchronous Treatment

Copenhagen, Denmark (UroToday.com)  Dr. O. Angerri, clinical urologist of the Fundació Puigvert center in Barcelona, Spain, presents a case report of a 64 year old male with hypertension who had a bilateral double-J stent placed due to acute renal failure. The patient had a completed staghorn stone in his left kidney and multiple ureteral stones in his right ureter. Dr. Angerri and his surgical team decided to perform an endoscopic combined intrarenal surgery (ECIRS) in the patient for treatment of bilateral stone disease. The procedure began by flexible cystoscopy to remove both double-J stents from the patient and placement of bilateral guidewires to both kidneys. Due to the intense stone burden of the left kidney, two percutaneous punctures were made: one in the inferior posterior calyx and the other in the medial posterior calyx. 

After the second puncture, a guidewire and safety guidewire was inserted into the kidney. Following this, a balloon catheter was inserted and inflated with 20 atmospheres, which created a 24 French nephrostomy access port. A flexible ureteroscope is then inserted into the distal ureter without a ureteral access sheath and guided in an antegrade fashion to the ureteral pelvic junction (UPJ) to begin to ablate the stone using laser lithotripsy. Through the previously created nephrostomy port, an 18 French nephroscope was also used to ablate the stone with laser lithotripsy from the opposite end of the stone. This was performed simultaneously with one surgeon performing the ureteroscopy lithotripsy while the other performed the percutaneous nephrolithotomy (PCNL). When enough of the staghorn stone was cleared, stone destruction and collection was moved into the upper and lower calyces to ablate all of the remaining stones in the left kidney. 

Following the completed procedure in the left kidney, a flexible ureteroscope was passed through the right ureter to remove the final ureteral stones. Following the clearance of all stones in the patient, bilateral double-J stents were placed and an 18 French nephrostomy tube was placed in the left kidney. The patient was discharged 3 days after the procedure without the nephrostomy. 


Presented by: Angerri O. Fundació Puigvert, Dept. of Urology, Barcelona, Spain

Co-Authors: Emiliani E. , Sánchez-Martín F. , Millán F. , Villavicencio H.
Author Information: Fundació Puigvert, Dept. of Urology, Barcelona, Spain

Written by: Zachary Valley and Zhamshid Okhunov, MD, (Department of Urology, University of California-Irvine) at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark