WCE 2019: The Future of Endourology

Abu Dhabi, United Arab Emirates (UroToday.com) The task of summarizing how Endourology has evolved over the years and projecting how the field may evolve in the future is no easy task. Fortunately, Dr. Glenn Preminger, a urologist at the Comprehensive Kidney Stone Center at Duke University Medical Center, stepped up to the task this morning in the Brazilian Endourology Society seminar at the World Congress of Endourology Conference.

Dr. Preminger centered his presentation around the central question: Where is the field of Endourology going? To answer this question, Dr. Preminger touched on a number of ongoing developments and innovations in different areas of endourology. These include improved percutaneous nephrolithotomy (PCNL) endoscopic-guided access, enhanced stone fragmentation with combination lithotripsies, reduced patient morbidities with “tubeless” (without a postoperative nephrostomy tube), augmented laser stone fragmentation via pulsed modulation and the new Thulium laser fiber, and more efficient fragment removal using ureteroscopic suction devices. With all innovations and advancements, Dr. Preminger emphasized that the end goal is to minimize patient complications and improve quality of life following surgical intervention.

Following his discussion of recent advancements in endourology, Dr. Preminger shifted his talk’s focus on discussing novel technology and practices that he believes will revolutionize endourological treatments in the coming years. He first mentions that he believes that the future of endourology lies with enhancements in endoscopic imaging. For example, Dr. Preminger discusses how digital URS will quickly overcome traditional fiberoptic URS as it has been shown to provide better vision and be far more efficient (with a 20-25% reduction in operative times) all the while providing similar stone free rates. In addition, he discusses the emergence of single-use flexible ureteroscopes, such as LithoVue, Maxiflex, WiScope, Axis, NeoFlex, Pusen, and Polyscope, that have sparked the interest of the urological community. These digital, single-use scopes, Dr. Preminger believes, have the potential to eventually allow for several added benefits to conventional ureteroscopy, such as more efficient stone removal, increased surgeon control, and improving feedback and communication to lasers being used during lithotripsy.

In conclusion, Dr. Preminger believes that as technological advancements and novel practices are introduced into the field of endourology, the field that we know and recognize today will drastically evolve in the coming years. From an immediate clinical standpoint, these changes will manifest themselves as endoscopic-guided PCNL will improve targeting of stone burdens, enhanced lithotripsies will help to remove stones faster, tubeless PCNL outcomes will work to reduce patient morbidities. In examining rapidly developing technologies, single use ureteroscopes will help to significantly reduce the cost of minimally invasive procedures, improved laser technology will enhance stone fragmentation and dusting, and URS suction devices, such as the Kalera stone aspirator, will lead to more efficient stone removal.

Presented by Glenn M. Preminger, MD, Comprehensive Kidney Stone Center at Duke University Medical Center, Durham, North Carolina, USA

Written by: Andrew Shea Afyouni, BS, Junior Research Specialist and Medical Student, University of California, Irvine Department of Urology at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates