UAA Lecture: Innovations in Renal Stone Surgery

Man-Kay LiSingapore Moderator

John DenstedtCanada Speaker UAA Lecture: Innovations in Renal Stone SurgeryInnovations in Renal Stone Surgery John Denstedt MD FRCSC Professor of Urology Schulich School of Medicine and Dentistry Department of Surgery Western University London Canada Recent years have seen a burst of innovation in techniques for minimally invasive treatment of renal stones. Current guidelines recommend either shock wave lithotripsy or retrograde intrarenal surgery {RIRS} for stones smaller than 2cm and percutaneous renal stone removal for calculi greater than 2cm in maximal diameter. Progress in mini percutaneous stone removal {mPCNL} has facilitated expansion of antegrade techniques to stones smaller than 2cm while concurrently RIRS has seen indications expand to include larger stones than previously considered. Most randomized trials have demonstrated similar operating times, hospital stays and complications comparing RIRS and MPCNL however stone free rates are generally documented to be improved with a percutaneous approach. Technology continues to advance and the development of flexible deflectable ureteral access sheaths with suction capability offer the possibility of improved stone free rates with RIRS while also decreasing intrarenal pressure, thus reducing the incidence of sepsis and other complications. This is challenging the traditional concept of limiting retrograde ureteroscopy to stones less than 2cm in diameter. This lecture will review the current literature on RIRS for intrarenal stones greater than 2cm, outlining expectations for the main parameters of stone free rate, complications and operating efficiency. Currently available technology and techniques will be presented allowing participants to take practical tips and tricks back to day to day urologic practice.