Other key stone disease/endourology topics from the 2016 AUA annual meeting included the use of aspirin in percutaneous nephrolithotomy patients as well as the continuing debate over the benefit of medical expulsive therapy.
Jodi Antonelli, MDOther key stone disease/endourology topics from the 2016 AUA annual meeting included the use of aspirin in percutaneous nephrolithotomy patients as well as the continuing debate over the benefit of medical expulsive therapy. The stone disease/endourology take-home messages were presented by Jodi Antonelli, MD, of the University of Texas Southwestern Medical Center, Dallas.
The new AUA/Endourological Society guideline on the surgical management of stones provides insight into imaging, preoperative testing, and the treatment of renal and ureteral stones in adults, children, and pregnant women. The guideline includes indications for active surveillance and surgical treatment, recommendations for surgical approach, and broadened indications for ureteroscopy over shock wave lithotripsy.
The learning curve for ultrasound-guided percutaneous nephrolithotomy may be as short as 20 cases, and adoption of this technique may dramatically reduce radiation exposure for patients and providers. Physicians improved over consecutive cases, with fluoroscopic screening time decreasing from 79.2 seconds over the first 20 cases to 11.1 seconds in the last 20 and success in puncture increasing from 30% over the first 20 cases to 100% in the last 20 cases.
The novel laser direct alignment radiation reduction technique for PCNL access showed impressively low access and total fluoroscopy times in an initial 25 cases. This may be a safe way to perform PCNL with reduced radiation exposure.
In patients with stones 5-20 mm in size, active basket extraction had a higher stone-free rate at 3 months compared to dusting but didn’t demonstrate a difference in other areas such as symptoms, reintervention, and readmission rates. Extended follow-up may provide more information.
PCNL may be safely performed in patients on aspirin. No significant differences in residual fragments, perioperative change in hemoglobin, hematocrit, and creatinine, or 30-day complication rate (bleeding or thrombotic events) were found in patients on aspirin therapy compared to those who were not.
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