PCNL challenges

@moeltemamy Excellent surgery!! How do you do the following , (time to set the Jj, time to pyelogram after take off JJ) thanks ) and how do you treat if reestenosis appear ?

Robotic management of long segment ureteric structures: different options. 1 - buccal 2 - appendix 3 - ileal ureter 4 - autotransplantation Let’s start today with buccal

PCNL still alive !!, best option for complex staghorn and matrix stones . Right kidney in this case four access, two mini and two standard, total time surgery 6 hours in two events .

@sopitas Nosa bia donde estaba la paleta pero luego la encontré la vi y ya mela quería comer

¡Reto visual de domingo! Este sí está medio complicado… ¿Pueden encontrar la paleta entre los heladitos? 🍦🍭🕵️ ¿Lo Lograron?

@EmaMarPa @Endo_Society @JEndourology @YAUEndourology @endouroacademy @CIEndourology @SauUrologia @so_uro One shot amplatz, even in Guy 3 or 4 or, if the Calix is completely occupied by stone, there is not difference between Alken, Amplatz or Ballon. Only exceptions in fibrosis try to use sequential amplatz and in hypermobility try to use Ballon.

📌In simple cases according to classification Guy`s GSS 1-2, which dilation method do you prefer❓ @Endo_Society @JEndourology @YAUEndourology @endouroacademy @CIEndourology @PCNL_challenges @SauUrologia @so_uro

Again implementing Simplified Biplanar Technique 0-90° By @urobraulio with success!✅ GSS 2. Puncture in Lower Calyx. Q: Prepare one shot dilation but perform dilation with Alken set. What is better? @Endo_Society @JEndourology @YAUEndourology @endouroacademy

@EmaMarPa @JEndourology @Endo_Society @ResidentesCAU @YAUEndourology When there is resistance the first is the skin, the second is the aponeurosis, there should not be extreme resistance unless there is excessive fibrosis, if there is no fasciotome, the aponeurosis must be opened with a scalpel even under fluoroscopy.

➡️Muscular Aponeurosis introduced in Alken set during dilation for PCNL😬 ⛔A simple but at the same time complex situation❌🤦‍♂️ @JEndourology @Endo_Society @ResidentesCAU @YAUEndourology @PCNL_challenges #ilovepcnl ❤

@REDPINE_Medical @KevinWymer @EndoLuminalEndo @wissamabokhalid @EdgarLindenMD @lucajavier @drjanakddesai @PCNLConvention Tubless when time’s surgery is short (less 90 min.), no injury to epithelium, no plan of second look , no in diverticulum and, when the urine punction is not present.

Do you prefer to the Tubeless when performing #PCNL? What do you consider more to place the Tube? #urinary stones #Urolithiasis @KevinWymer @EndoLuminalEndo @wissamabokhalid @EdgarLindenMD @lucajavier @PCNL_challenges @drjanakddesai @PCNLConvention

@EmaMarPa @ESRUrology @ResidentesAEU @PETRAurogroup @so_uro @Endo_Society @YAUEndourology @BAUSendourology Excellent punction too, although the infundibulum is wide, it is very important to perform transpapillary approach to avoid accidents.

A Day with PCNL. Big Renal Pelvis Stone in Left Kidney! 4.3cm Standard 24 Fr. #PCNL Totally SFR. Supine Barts Flank-Free position. @ESRUrology @ResidentesAEU @PETRAurogroup @PCNL_challenges @so_uro @Endo_Society @YAUEndourology @BAUSendourology

@EmaMarPa @ESRUrology @ResidentesAEU @PETRAurogroup @so_uro @Endo_Society @YAUEndourology @BAUSendourology Excellent job , a perfect case for supine position !!!

Choosing the best calix and the best position!! Some times the calix is parallel to spin and is inaccesible to Valdivia position. If you don’t have flexible instruments you have to do more than two tracts.

@Dosbave Claro sería un honor !!

@PCNL_challenges excelente, hay posibilidades de conversar para cambiar ideas. gracias

Sclerotherapy of renal cyst by percutaneous approach: 1 pyelography, 2 ultrasonography, 3 puncture and confirm with contrast, 4 drainage, 5 alcohol sclerotherapy 20% of the liquid obtained, leave 1 hour closing and go for 24 hrs later to reintroduce alcohol 20% again of liquid.

@DrPNMaheshwari Indication for sclerotherapy in this patient was pain. Size for better punction above 5 cm, minimal risk of bleeding more common infection , one session in majority of cases is enough but , is important ultrasonography confirmation.

@PCNL_challenges What are you're indications? Any size limitation? What are the risks (infection, bleeding)? How many sessions needed?

@uro_corona @saadwael738gma1 I ‘ll try to do a infundibulothomy by percutaneous acces upper pole, and set a foley #18 in pelvis but just one time , if development another recurrence avoid the case !!!

@saadwael738gma1 @PCNL_challenges How do you treat these cases when they recur?

Infundibular stenosis caused by fibrosis of upper calyx, open by laser under renoscopy, tips: use low energy , high frequency, start opening in areas with scar, pale or mimic Randall plaque lesions, pass a guide. Leave catheter jj for one month and wait for re-epithelialization.

@VicentiniUro @Endo_Society @endourologyccf @BEkidneystone @urobraulio @GuidoGiusti @Urologeman @ytanidir @2fabiosepulveda Agree it looks matrix stone!!

Guys, this is a PCNL for a different kidney stone... What is happening?? @Endo_Society @endourologyccf @BEkidneystone @urobraulio @GuidoGiusti @Urologeman @ytanidir #UroSoMe @2fabiosepulveda

@DrUbaidUrRahma1 @UroHRAEPY

Inicia la preselección y convocatoria para Fellowship en endourologia ☄️💥⚡️@UroHRAEPY drive.google.com/open?id=1LZlyG…

Fellowship endourology

52YO 🚺 Bilateral lithiasis, BMI 36 PCNL double tract ☄️ one of them (inferior calix) usg guided and without nephrostomy... a second look will be needed 🤯. @UroHRAEPY @juanjoselascano @PCNL_challenges (not available simple TC) #UroSoMe

@2fabiosepulveda @Urologeman I think would be better take renal gammagram before to take action, if is really convenient save the kidney or not. The parenchyma looks very thin, less 7 cm.

@Urologeman This is the CT before the first approach. We don’t have #MiniPCNL in public health system. I made standard 24Fr access. Some urologists would recommend an open surgery to perform infundibuloplasty and avoid recurrence. I don’t believe that. Anyone does? #UroSoMe #UroSoMeBrasil

The “bonsai tree” stone: one of the most complex staghorn stones. Large stones in calyces with narrow and long infundibulae make it hard to navigate inside the kidney. Almost one acces per stone. 2nd look #PCNL where 3 access were made. #UroSoMe #UroSoMeBrasil