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Cheng-Chia LinTaiwan
Speaker
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
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Cheng-Chia LinTaiwan
Moderator
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
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Yi Quan TanSingapore
Speaker
How Suction Changed My Hospital Practice of Flexible UreteroscopySuction in Endourology has truly been a gamechanger in recent years. In this talk, Dr Yi Quan Tan discusses how rapid technological advancements have evolved his hospital's practice of performing RIRS. Working alongside Dr Vineet Gauhar in the Endourology unit at Ng Teng Fong General Hospital in Singapore, Dr Tan provides a glimpse of how early adoption of new technology and concepts have helped push boundaries and improved RIRS outcomes for their patients.
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Han Kyu ChaeKorea (Republic of)
Speaker
Endoscopic Combined Intra Renal Surgery: New FrontiersBackground:
Endoscopic Combined Intra Renal Surgery (ECIRS) has evolved as a versatile approach that combines the strengths of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), allowing for simultaneous anterograde and retrograde access. This dual approach has shown advantages in treating large or complex renal stones, including full or partial staghorn calculi, particularly in cases where monotherapy may be suboptimal.
Objectives:
This lecture will explore recent advancements in ECIRS, highlight regional practices in Asia, and propose future directions that may redefine the standard of care in endourology.
Key Topics Covered:
Technical evolution: From prone to modified supine position; advancement in ultra-mini PCNL and flexible ureteroscopy integration.
Instrument synergy: Role of suction PCNL systems and navigable ureteroscopes in optimizing stone clearance and reducing operative time.
Asian perspective: Surgical position, tract size, and imaging modality preferences vary across countries, reflecting diverse adaptations and innovations in ECIRS techniques.
Clinical outcomes: Review of recent multicenter data showing ECIRS's impact on stone-free rates, complication reduction, and postoperative recovery.
Future frontiers: Integration of AI-guided navigation, pressure-controlled irrigation systems, and 3D intraoperative imaging to refine intrarenal surgery.
Conclusion:
As endourological technology advances, ECIRS stands at the intersection of innovation and practicality. The next frontier lies not only in technical refinement but also in tailoring approaches to anatomical and cultural variability across Asia. This session aims to foster collaboration and knowledge sharing to drive further evolution in combined intrarenal stone surgery.
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Boyke SoebhaliIndonesia
Speaker
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
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Anil ShresthaNepal
Moderator
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
Chinnakhet
Ketsuwan Thailand
Moderator
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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Takaaki InoueJapan
Speaker
New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Albert El HajjLebanon
Speaker
Battle of the Robots in Flexible Ureteroscopy: What's the Verdict?AAU Lecture: Robotic Flexible Ureterorenoscopy— Gimmick or a True Helper? What’s It Cost Performance Value?
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Jeremy TeohHong Kong, China
Speaker
Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
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Hsiang-Ying LeeTaiwan
Speaker
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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Albert El HajjLebanon
Moderator
Battle of the Robots in Flexible Ureteroscopy: What's the Verdict?AAU Lecture: Robotic Flexible Ureterorenoscopy— Gimmick or a True Helper? What’s It Cost Performance Value?
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Azimjon TursunkulovUzbekistan
Speaker
How to Perform Supine PCNL in Pediatrics? Is It Different from Adults?Percutaneous nephrolithotomy (PCNL) is increasingly favored as a minimally invasive method for treating kidney stones, especially in the supine position, due to its benefits for anesthesia, ergonomics, and overall patient safety. However, when performing supine PCNL in children, urologists encounter distinct challenges that differ significantly from adult patients. In this presentation, we will discuss the key differences and specialized techniques required to successfully and safely perform supine PCNL in pediatric cases.
Important considerations in pediatric patients include their smaller anatomical size, larger stone-to-kidney size ratios, increased sensitivity to fluid overload, and greater vulnerability to radiation exposure. Particular care is needed in patient positioning due to fewer clear anatomical landmarks, making precise ultrasound-guided kidney access crucial to minimize radiation and enhance accuracy. The use of specially designed miniaturized instruments is essential for pediatric procedures, alongside careful management of fluid to prevent complications.
Drawing from extensive personal experience and evidence-based practices, this presentation will cover practical adjustments, such as optimal patient positioning, precise kidney puncture techniques, careful tract dilation, nephroscopic approaches, effective stone removal strategies, and tailored postoperative care. This presentation aims to provide attendees with practical insights and techniques to enhance their approach to supine PCNL in pediatric patients, supporting outcomes comparable to those achieved in adult cases.
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Shemeem Kachereente VitaQatar
Speaker
ESWL for Ureteric Stones: Art of Achieving 100% Stone Free RateExtracorporeal Shock Wave Lithotripsy (ESWL) remains a valuable, non-invasive option for managing ureteric stones, despite growing preference for endoscopic approaches. In this talk, I will share insights from over 40,000 ESWL procedures performed at our center, with a focus on optimizing technique, patient selection, and procedural nuances that have allowed us to consistently achieve near-complete clearance rates—even for distal and impacted stones.
Key points include:
Understanding anatomical and technical factors that influence ESWL success
Strategies to overcome limitations traditionally associated with ureteric stone location
The role of stenting, pain control, and imaging in maximizing outcomes
Real-world evidence demonstrating ESWL’s continued relevance in modern stone management
This session aims to reignite interest in ESWL by presenting practical, reproducible methods that can raise clearance rates close to 100%, when done with precision and experience.
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Hsiang-Ying LeeTaiwan
Facilitator
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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Vineet GauharSingapore
Speaker
Experimental and Real World Take Away Messages on DISSSuction in Renal Stone Treatment: DISS, FANS or Combined Procedure?Need of Future EndourologyChoosing the Correct Laser and Flex Scope Combination in Suction Ureteroscopy Can Be the Deal Breaker
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Joy CastilloPhilippines
Moderator
Advance Course of Urolithiasis & Technology, Company Sponsored SymposiumWith continuous innovations in endourology, particularly in the field of retrograde intrarenal surgery (RIRS), the role of intrarenal pressure (IRP) has emerged as a key factor influencing surgical outcomes. This session will delve into the growing body of evidence linking elevated IRP to complications such as postoperative infections, renal injury, and reduced stone-free rates.
The symposium will also introduce a focused discussion on pressure management strategies during RIRS, highlighting the Tidor System—an advanced platform designed to monitor and regulate IRP in real time. By combining current evidence with practical solutions, this session aims to equip urologists with a deeper understanding of IRP’s clinical impact and how emerging technologies can enhance safety and efficacy in stone surgery.
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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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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Vineet GauharSingapore
Moderator
Experimental and Real World Take Away Messages on DISSSuction in Renal Stone Treatment: DISS, FANS or Combined Procedure?Need of Future EndourologyChoosing the Correct Laser and Flex Scope Combination in Suction Ureteroscopy Can Be the Deal Breaker
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Steffi YuenHong Kong, China
Speaker
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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Boyke SoebhaliIndonesia
Moderator
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
Takaaki InoueJapan
Moderator
New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Anil ShresthaNepal
Speaker
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
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Deepak Ragoori India
Speaker
How to Use Clearpetra Shetah to Minimize Post Operative Stenting after FANS
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TICC - 2F 201DE
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