A panel of experts will review several complex stone cases during a 30-minute plenary presentation Tuesday morning. Ben Chew, MD, MSc, FRCSC, will moderate the Complex Cases session on Stones, which will begin at 9:30 a.m. in Ballroom East of the Boston Convention and Exhibition Center.
“This is a session that is intended to be very practical and to provide guidance to the urologist on how to deal with some sticky situations,” said Dr. Chew, associate professor in the Department of Urologic Sciences at the University of British Columbia and Director of Clinical Research at Vancouver General Hospital’s Stone Centre.
“The panelists will offer some practical advice for ureteroscopy involving techniques that, for example, could help avoid ureteral strictures and avulsion, among other issues,” Dr. Chew said. “They will also discuss some of the latest research comparing dusting a stone into fine fragments versus basketing, where larger pieces are actively extracted.”
The panel will review the EDGE (Endourology Disease Group for Excellence) Research Consortium’s latest results, which included a distinct, statistically significant advantage in stone-free outcomes with the basketing technique.
“There was previously very little data on this, and it was unclear which technique would yield the more promising outcomes. We truly didn’t know which one was going to be better,” Dr. Chew said.
The panelists will use case discussions to evaluate percutaneous nephrolithotomy techniques, including the benefits of supine versus prone patient positioning.
“Anesthesia loves the supine position because patients are easier to ventilate,” Dr. Chew said. “Ureteroscopy can also be performed at the same time when the patient is in a supine position, which can be more challenging in a prone position.”
Proponents of the supine position also argue that a supine position makes the procedure easier for the surgeon, who can sit down instead of standing throughout the operation.
“In terms of the data that’s out there, though, it’s relatively equal between the two positions for PCNL,” Dr. Chew said. “There hasn’t been an advantage in terms of stone-free rates, operative time or bleeding. That’s all been fairly similar. It’s more that the positioning is a bit easier for anesthesia and the other people involved in the procedure.”
The session’s panelists include Silvia Proietti, MD, FEBU, a urologist at San Raffaele Hospital and Vice Director of the European Training Center of Endourology in Milan, Italy, and Brian H. Eisner, MD, assistant professor of Surgery at Harvard Medical School and Co-director of Massachusetts General Hospital’s Kidney Stone Program.