Dr. Song discusses challenging kidney stone cases

In this video, Joseph Song, MD, describes some challenging kidney stone cases. Song is a urologist with Georgia Urology.

Transcription:

Kidney stone treatment is all about access. Whether you're doing it ureteroscopically or doing it percutaneously, if you have good access, if you have good flow, then it makes your surgery that much easier. But if you're limited in access, whether that's because you couldn't get a sheath up the ureter, or whether they have an obstructed calyx, or whether you have an anatomy where you're around the corner of a corner, that makes things much, much more difficult. So recently, I had a young lady who was 26, and she had just a kidney completely full of stone, but I had good access; I was able to get in and I was able to do the PCNL in about 30 minutes [and send her] home the same day without a tube. I had a patient the same exact age but had Lesch–Nyhan syndrome and horseshoe kidneys...and his stones were softer. The access was just as good, but his anatomy made it so that the tube could barely reach the far side of the renal pelvis. The tube kept on sliding underneath the surface of the skin, and then you would have to spend 10, 20 minutes sweating bullets, like I lost the tube inside of this patient and I can't get it back out, so then I put some silk stays on either side of it so that I could, when it did that, I was able to angle it back out. That's something I've never seen before during training and never had to do prior to that. That's my tip of the day. If you're doing a PCNL and the patient's got a horseshoe kidney or some other kidney that your nephrostomy tube that you put in is barely at the skin level, go ahead and put a stitch in that because if it slips under and you're having to enlarge an incision and you're trying to get it out, it's so much more difficult once that's happened, but if you have that access, it's so much easier.

This transcription was edited for clarity.