Kidney Stones

Overcoming challenges of medical therapy starts with leveraging guidelines.

Advances in robotic URS will help target stones and reduce ionizing radiation.

Researchers in Tennessee are finding success with the use of an Enhanced Recovery After Surgery pathway that provides standardization for the anesthetic care and postoperative management of patients undergoing ureteroscopy and stent placement with a novel approach that minimizes opioid exposure.

Documentation must support performance of ‘unusual services,’ according to Ray Painter, MD, and Mark Painter.

A study presented at the AUA annual meeting in Chicago shows higher rates of emergency department (ED) visits when ureteral access sheaths are used during ureteroscopy to remove kidney stones.

Forgotten stents are one of the most common challenges urologists and their patients face, and they can cause significant complications and increase costs of care. Now, a program that tracks stent insertion and removal in the electronic medical record shows strong potential to help eliminate retained stents.

High rates of residual fragments after ureteroscopy point to the need to both improve selection of patients for this procedure and find ways to boost stone-free rates, according to researchers at UT Southwestern Medical Center, Dallas.

In this interview, Juan Calle, MD, discusses how he follows patients once they are stone free and how he utilizes dietary/lifestyle modification and medical management.

In this video, Juan Calle, MD, of Cleveland Clinic, explains what he would tell a young urologist who wants to become an expert in stone prevention and minimizing recurrence.

In this video, Bodo Knudsen, MD, of The Ohio State University Wexner Medical Center, Columbus, explains his step-by-step process for obtaining percutaneous access in stone patients.

In this interview, Bodo Knudsen, MD, outlines his step-by-process for obtaining percutaneous access, discusses the ways he reduces radiation exposure during percutaneous nephrolithotomy, and gives his thoughts on how clinicians can gain proficiency with access.

The high-power holmium laser with Moses technology (Lumenis Moses Pulse 120H) and the super-pulse thulium fiber laser (SPTF) have a similar ablative effect when operated at the same power, but when evaluated at maximal dusting settings, the SPTF laser seems to hold an advantage for greater efficiency, according to research reported at the AUA annual meeting in Chicago.

Patients with ureteral stents are rarely lost to follow-up, but the risk is increased when patients are stented in an emergent setting rather than as part of an elective procedure, Yale University urologists reported at the 2018 World Congress of Endourology in Paris.  

The Painters also answer coding questions regarding prostate needle biopsy and InterStim.

Dr. Dangle shows that pediatric ureteroscopy is safe and feasible with good results and without long-term sequelae on the ureters.

This video shows a case of semi-rigid ureteroscopy with laser lithotripsy for ureteral stone in a child, who is rendered stone free without pre-stenting. 

This video of bilateral ureteroscopy in a 16-year-old male with cystinuria highlights several pragmatic strategies for efficient ureteroscopy while minimizing ionizing radiation.

A study examining opiate use after ureteroscopy found that younger age and greater number of preoperative opiate prescriptions were associated with the filling of additional opiate prescriptions.

A novel investigational ureteral access sheath force sensor served as an effective tool for the safe deployment of a ureteral access sheath in initial clinical experience, researchers reported at the 2018 World Congress of Endourology and SWL in Paris.

Super-mini percutaneous nephrolithotomy may have some advantages over retrograde intrarenal surgery when treating 1- to 2-cm lower pole renal calculi, according to a comparative study.

Implementation of a hospital-wide clinical care protocol for managing obstructive pyelonephritis and sepsis from stones shows potential for improving patient outcomes, according to the experience of researchers at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York.

Discharging patients without opioids for pain control after undergoing outpatient ureteroscopy with stent placement appears to be feasible, results of a pilot study show.  

"The concept of 'surgical quality' is emerging as an important component of health care delivery. At present, though, there is no universally accepted definition of what surgical quality is; indeed, this term may mean different things to different physicians, patients, and others," writes Brian R. Matlaga, MD, MPH.

An analysis of nearly 2,000 patients undergoing ureteroscopy found that approximately 10% of the cohort had an emergency department visit after the procedure, a figure a statewide quality improvement initiative is looking to reduce via patient education regarding ureteral stents.

In this interview, Andrew Portis, MD, discusses his experience with ureteral access sheaths and describes an algorithm for their selection and use. 

In this interview, Margaret S. Pearle, MD, PhD, discusses the AUA’s guideline on medical management of stone disease and also touches on disposable ureteroscopes and percutaneous access.

The development of an ultrasonic stone propulsion system marks a significant advance in the treatment of kidney stones. This video explains how the system, which is still in development, is used to facilitate stone passage.

Pretreatment for 14 days with tolterodine (Detrol) and Tamsulosin (Flomax) did not appear to relieve ureteral stent symptoms better than tamsulosin alone as measured by the validated Ureteral Stent Symptom Questionnaire, say the authors of a recent study.

Results of a study evaluating health-related quality of life in patients surgically treated for kidney stones suggest a need to rethink the outcome target and focus on patient counseling to set appropriate expectations.

Also learn about a new stone device, an at-home testosterone enanthate injection, and more.