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V29 Micropercutaneous nephrolithotomy in Galdakao modified supine Valdivia position
Title
V29
Micropercutaneous nephrolithotomy in Galdakao modified supine Valdivia position Eur Urol Suppl 2015;14/2;eV29
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Hoznek A. 1 , Castellan P. 2 , Chiaradia M. 3 , Parier B. 1 , Khan M.H. 4 , De La Taille A. 1 1 CHU
Henri Mondor, Dept. of Urology, Creteil, France, 2 SS. Annunziata Hospital, Clinica Urologica, Chieti, Italy, 3 CHU Henri Mondor,
Service D'Imagerie Médicale, Creteil, France, 4 Airedale General Hospital, Dept. of Urology, Keighley, United Kingdom INTRODUCTION & OBJECTIVES: 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 left kidney pelvis 1.400 HU
Dusting
Double-J stent for 4 days
#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
Ureteric catheter overnight
8 mm lower pole of left kidney inaccessible with RIRS
Micro-ECIRS, dusting
Ureteric catheter overnight
Staghorn stone in left kidney
MiniPerc through lower calix, MicroPerc through mid-calyx
16 Fr nephrostomy for 2 days
# 45 year old female, residual stone after PCNL for 3 staghorn, recurrent UTI, failed RIRS #4
62 year old male, tetraplegic, ileal conduit, bilateral staghorn stone, recurrent UTI
RESULTS: All procedures were completed successfully without any significant residual fragment. No complication occurred. CONCLUSIONS: Micropercutaneous nephrolithotomy favourably completes surgical armamentarium in specialized stone centers. It can be proposed as an alternative to retrograde intrarenal surgery in particular cases, it may be the optimal treatment in specific anatomical configurations of the collecting system or may be proposed as a supplement to flexible ureteroscopy or percutaneous nephrolithotomy.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/V29.html[19/02/2015 08:25:25]
V29
Micropercutaneous nephrolithotomy in Galdakao modified supine Valdivia position Eur Urol Suppl 2015;14/2;eV29
Print! Print!
Hoznek A. 1 , Castellan P. 2 , Chiaradia M. 3 , Parier B. 1 , Khan M.H. 4 , De La Taille A. 1 1 CHU
Henri Mondor, Dept. of Urology, Creteil, France, 2 SS. Annunziata Hospital, Clinica Urologica, Chieti, Italy, 3 CHU Henri Mondor,
Service D'Imagerie Médicale, Creteil, France, 4 Airedale General Hospital, Dept. of Urology, Keighley, United Kingdom INTRODUCTION & OBJECTIVES: 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 left kidney pelvis 1.400 HU
Dusting
Double-J stent for 4 days
#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
Ureteric catheter overnight
8 mm lower pole of left kidney inaccessible with RIRS
Micro-ECIRS, dusting
Ureteric catheter overnight
Staghorn stone in left kidney
MiniPerc through lower calix, MicroPerc through mid-calyx
16 Fr nephrostomy for 2 days
# 45 year old female, residual stone after PCNL for 3 staghorn, recurrent UTI, failed RIRS #4
62 year old male, tetraplegic, ileal conduit, bilateral staghorn stone, recurrent UTI
RESULTS: All procedures were completed successfully without any significant residual fragment. No complication occurred. CONCLUSIONS: Micropercutaneous nephrolithotomy favourably completes surgical armamentarium in specialized stone centers. It can be proposed as an alternative to retrograde intrarenal surgery in particular cases, it may be the optimal treatment in specific anatomical configurations of the collecting system or may be proposed as a supplement to flexible ureteroscopy or percutaneous nephrolithotomy.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/V29.html[19/02/2015 08:25:25]