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