EAU 2018: Urological Association of Asia Lecture Experience with 'Mega Stones' Treatment
Dr. J Mastuzaki joined the EAU 2018 congress with a plenary discussion on his institution’s experience on the treatment of what he terms ‘mega-stones’. His series of 88 patients from April 2011 to October 2017 had an impressive mean stone size of 63 mm [range: 50-102mm], mean stone surface of 2028mm squared [range 752-4403], and mean stone volume of 22.5ml [range 7.8-97.6]. The overall complication rate among these 88 patients was 25.6%, with transfusion required in 1 patient with a pseudo-aneurysm. Of note, there were no splanchnic injuries or deaths and no perioperative anesthesiology-related problems.
In follow-up to the aforementioned results, Dr. Matsuzaki recommends the endoscopic combined intra-renal surgery, in which endoscopy, fluoroscopy, and ultrasound are combined in a PCNL procedure via a modified supine Valdivia position.
As an example, Dr. Matsuzaki presents a case of a 68 year old female presenting with left back pain due to a left renal stone with dimensions 67mm x 36mm. Upon CT KUB, it was found that the upper hydrocalyx volume was 23.99ml and the patient underwent endoscopic combined intra-renal surgery. A UAS 11/13Fr, 36cm scope was used [Olympus URF-P6] and puncture was performed at the upper calyx and dilated with a 24Fr balloon sheath. Overall operative time for this case was 127 minutes and the patient’s estimated radiation exposure was 1.7 minutes.
In conjunction with the total case experience of 88 patients treated via this technique and the step-by-step case presentation, Dr. Matsuzaki concludes his presentation with the assertion that the endoscopic combined intra-renal surgery has been the standard practice for patients presenting with stones > 5 cm at his institution. Due to the ureteroscopic assistance, puncture, dilation, and extraction of the stones this procedure has proven to be both safer for the patient and easier for the surgeon.
Overall, this novel approach to treatment of mega-stones has yielded promising results in confirmation via a large cohort. Due to the relatively homogenous sample in this group and limitations to one single center, however, the urologic community is looking forward to confirmation via larger series with a more diverse patient population.
Presented by: J Matsuzaki, MD. Yokohama City, Japan
Written by: Linda M. Huynh, BS, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark