Urolithiasis 2
16 Aug 2025
15:30
17:00
TICC - 2F 201DE
Diversified Approaches to Stone Management
UAA Congress 2025 has prepared an outstanding series of sessions on urinary stone disease, featuring leading experts from across Asia. Topics will include the latest trends in stone management, practical techniques for DISS, FANS, and intrarenal pressure monitoring, a comparative overview of different laser technologies, the application of AI in stone surgery, and tips for ECIRS positioning. With such a diverse and cutting-edge program, the event promises to be both informative and inspiring. We warmly welcome all professionals and enthusiasts in the field of stone disease to join us and share their insights.
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15:30
15:40
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Deok-Hyun HanKorea (Republic of)
Speaker
The Era of ECIRS: Prone Still Matters!Endoscopic combined intrarenal surgery (ECIRS) couples antegrade and retrograde endoscopy to raise stone-free rates while limiting morbidity. Although the Galdakao-modified supine position is widely used, surgeons experienced with prone percutaneous nephrolithotomy (PCNL) can realize distinct advantages when ECIRS is performed in the prone split-leg position. This lecture reviews practical operating-room setup and positioning—including feasible workarounds when a split-leg positioner is unavailable—monitor layout, and puncture trajectory planning. It details endoscope-guided puncture and coordinated intrarenal navigation, and highlights scenarios where prone ECIRS is particularly advantageous: posterior and upper-pole access, narrow calyces, complex collecting-system anatomy, and situations requiring stable distension and visualization. We discuss how prone positioning can improve irrigation dynamics, enable a “vacuum-cleaner” effect for fragment clearance, reduce thermal injury risk, and limit retrograde fragment migration—often without a ureteral access sheath. Strategies for comprehensive residual-fragment assessment and efficient D-J stent placement are outlined, along with trade-offs (airway considerations, workspace and monitor configuration, and the brief learning curve for retrograde orientation). In sum, prone ECIRS is a feasible, reproducible extension of prone PCNL that offers a natural transition path for prone PCNL surgeons and may improve stone-free outcomes in selected patients. Further prospective data and standardized workflows will refine its role.
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15:30
17:00
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Yi-Sheng TaiTaiwan
Moderator
Which Laser for RIRS: Thulium Fiber Laser Thulium Fiber Laser (TFL)is a type of fiber laser, distinct from Thulium laser used for prostate surgey. It’ a cutting-edge laser and rapidly gaining traction in urology The machine is compact, portable, quiet with air-cooling, and lower power consumption.It employs a thulium-doped silica fiber powered by diode lasers, emitting light at 1940 nm, matching water absorption peaks. This results in a high absorption coefficient and shallow penetration (~0.1 mm), enabling precise energy delivery and minimizing tissue damage.Compared to Holmium lasers, TFL operates at lower energies (down to 25mJ) and higher frequencies (up to 2000Hz) for delicate tissue ablation and fine stone dusting.
The most notable change is pulse modulationHo:YAG lasers has Spike-shaped pulses and indicate greater energy concentration, resulting in higher localized heating, uneven fragmentation, and increased retropulsion.TFL produces pulses with uniform energy distribution and lower peak power, resulting in consistent ablation with less retropulsion and fewer thermal spikes.Higher water absorption rapidly forms a vapor channel, enhancing ablation efficiency.
But, TFL is not as ideal in surgical scenarios. At settings of low pulse energy (0.2 J) and high frequency (100 Hz), it tends to cause troublesome char formation and spark generation, particularly when treating calcium phosphate stones. These phenomena, explosive combustion and carbonization can reduce ablation efficiency and increase the risk of thermal damage and fiber degradation. Optimizing TFL settings is very important for outcome and safety and ongoing evaluation. AI in Medical Imaging – Converting 2D Black & White to 3D and Applications in Mixed Reality (MR) used in RIRS Artificial Intelligence (AI) and Extended Reality (XR) are at the forefront of innovation in modern medicine. In endoscopic surgery, these technologies are increasingly being integrated to enhance procedural precision and intraoperative guidance.
One experimental application involves using AI to convert 2D CT scans into 3D visualizations, offering surgeons a more intuitive understanding of anatomical structures. Devices like the Apple Vision Pro may be used to create fully immersive virtual environments, although it is not currently approved as a medical device.
In clinical practice, Mixed Reality (MR)—which blends real and virtual environments with real-time interaction—has shown promise. MR has been used during Retrograde Intrarenal Surgery (RIRS) to reduce the risk of missed stones, and in Endoscopic Combined Intrarenal Surgery (ECIRS) to overlay anatomical data, improving puncture accuracy during Percutaneous Nephrolithotomy (PCN).
As an emerging field, further advancements will depend on enhanced imaging resolution, improved intrarenal navigation and integration of AI-driven real-time stone detection.
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15:40
15:53
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Hung-Yi ChenTaiwan
Speaker
How to Use Intrarenal Pressure Monitoring to Identify Risky Steps during RIRS Surgery, and the Function of FANS.Intrarenal pressure (IRP) elevation during retrograde intrarenal surgery (RIRS) is associated with increased risks of renal injury and infection. Real-time IRP monitoring enables identification of risky procedural steps—such as access sheath insertion, stone fragmentation, and basketing—where pressure spikes commonly occur. Recognizing these moments allows timely adjustments to irrigation and technique. The Flexible and Navigable Suction Ureteric Access Sheath (FANS) plays a key role in pressure management by facilitating continuous suction and efficient outflow, thereby reducing IRP and improving visibility. Incorporating both IRP monitoring and FANS enhances surgical safety and may improve patient outcomes in RIRS.
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15:53
16:03
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Yi-Yang LiuTaiwan
Speaker
Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required.
Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm.
Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs.
In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required.
ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
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16:03
16:13
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Ching-Heng YenTaiwan
Speaker
What are the New Supportive Modalities in the Horizon to Increase the Efficacy of ESWL Extracorporeal shock wave lithotripsy (ESWL) has long been a standard non-invasive modality for managing urinary stones, yet its efficacy remains suboptimal in certain scenarios due to variable stone composition, size, and anatomical factors. Recent advancements have introduced several supportive modalities aimed at enhancing stone fragmentation and clearance. Among these, Burst Wave Lithotripsy (BWL) emerges as a promising technology utilizing focused, low-intensity ultrasound bursts to achieve finer stone fragmentation with greater precision and reduced tissue injury. In parallel, adjunctive approaches such as external physical vibration, ultrasonic propulsion, and optimized patient positioning are gaining traction. Pharmacologic aids including alpha-blockers and potassium citrate have also demonstrated improved stone passage rates post-ESWL. Furthermore, artificial intelligence–driven targeting and real-time imaging advances contribute to improved shock wave focusing and treatment personalization. This review explores the evolving landscape of supportive technologies, with a focus on BWL and its integration with existing ESWL protocols, potentially reshaping the future paradigm of non-invasive stone management.
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16:13
16:23
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Hsiang-Ying LeeTaiwan
Speaker
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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16:23
16:33
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Chinnakhet
Ketsuwan Thailand
Speaker
Intra Renal Pressure Defines Outcomes: Current EvidenceIntrarenal pressure (IRP) is a crucial physiological parameter during endourological interventions, as elevated IRP is closely linked to increased fluid absorption, intrarenal backflow, compromised renal perfusion, and postoperative complications. Experimental studies in animal models have consistently demonstrated a correlation between increased IRP and augmented irrigation fluid absorption, renal parenchymal backflow, and reductions in renal blood flow. Clinical studies have reported baseline IRP values ranging from 14 to 17 mmHg, with transient peristaltic peaks reaching up to 25 mmHg. Notably, IRP frequently surpassed 60 mmHg during endoscopic procedures, particularly when utilizing manual hand-pump irrigation or employing ureteral access sheaths (UAS) with smaller diameters. Significant risk factors identified for sustained elevations of IRP include non-prestented ureters, Asian ethnicity, and omission of UAS placement. Furthermore, elevated IRPs have demonstrated a direct association with infectious adverse events, notably postoperative sepsis. Randomized controlled trials have established that manual hand-pump irrigation generates substantially higher IRPs compared to pressurized irrigation bags. Additionally, serial manual irrigation boluses have been shown to produce prolonged IRP elevations, with maximum peaks exceeding 100 mmHg and durations surpassing 40 seconds. Collectively, both preclinical and clinical evidence underscores the necessity of meticulous intraoperative IRP management during endourological procedures. Strategic optimization of irrigation techniques and appropriate UAS selection are imperative to effectively maintain IRP within safe physiological limits, thereby minimizing the risk of complicationsRole of VR/AR/MR in Endourology and Urolithiasis Renal stone disease is a common urological condition affecting diverse patient populations. Percutaneous nephrolithotomy (PCNL) is widely recognized as the primary treatment for large or complex renal calculi, offering high stone-free rates with low complication profiles. Nevertheless, achieving accurate percutaneous renal access (PCA) remains technically challenging due to anatomical proximity to vital structures and insufficient hands-on training opportunities for urologists. Virtual reality (VR) simulators, such as the PERC Mentor and Uro Mentor, have demonstrated significant improvements in PCA proficiency, operative efficiency, and complication reduction, establishing their validity as effective training platforms. Additionally, mixed reality (MR) and 3D holographic technologies, exemplified by HoloLens, enhance surgical planning and procedural accuracy, particularly in calyceal targeting during PCNL. Recent nationwide training needs assessments have further advocated for the integration of these advanced simulation technologies into urological education curricula. Ultimately, systematic incorporation of VR and MR simulation into residency training holds substantial promise in bridging existing skill gaps, refining surgical competencies, and circumventing ethical concerns associated with traditional methods of surgical education.
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16:33
16:43
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Manint UsawachintachitThailand
Speaker
What I Need as a Clinician in Single Use ScopesSpecial Consideration in Pediatric Endourology
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16:43
16:55
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Sung Yong Cho Korea (Republic of)
Speaker
Robotic URS: Can It Really Improve Precision and Reduce Surgeon Fatigue?Use of AI and Robots in Endourology
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16:55
17:00
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