Munich, Germany (UroToday.com) With the advancement of endoscopic technology, ureteroscopy (URS) has emerged as an effective treatment modality for ureteral and smaller kidney stones. Dr. Traxer provided excellent overview of the current state of endoscopic and ureteroscopic technology. He shared his expertise on the use of URS, proper patients selection, ancillary instrumentation for URS, laser fibers, dusting vs. fragmentation laser setting and more.
Dr. Traxer started with an overview of current guidelines for the management of of kidney and ureteral stones. He highlighted that URS is a viable treatment modality for lower pole kidney stones less than 2cm in size. He demonstrated his own data as well literature review on the outcomes of URS on lower pole stones.
He highlighted that it is essential to properly prepare the patients, select the type of laser and laser settings. He recommended that the smallest laser fibers are encouraged to use due to the fact that scopes will be needed to deflect into the lower pole to manage the stone. He said that the optimal fiber size is <275 microns.
Dr. Traxner suggested that patients must under general anesthesia; this will allow the surgeon and the anesthesiologist to control the patients breathing to limit the stone move during URS> He continued with laser setting and reinforced the methodology and laser setting for dusting. If the stone type allows the stone to be dusted, lower laser setting must be used. Ureteral access sheath must be used at all times to reduce the pressure in the kidney. Additionally, this will help to clear the stone by facilitating the stone passage towards the lower pressure in the sheath. He discussed the contemporary double lumen scopes and their superiority to other devices in terms of the irrigant flow and visualization during the procedure. Overall, URS is an effective and safe treatment modality for ureteral stones and patients with selected kidney stones.
Presented By: Oliver Traxer
From the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany