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MiniECIRS for a ureteric stone with multiple calyceal stones in the ipsilateral kidney

Boston Scientific

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2019

Patient was placed in the Galdakao-modified supine Valdivia position. The double J stent was removed and a semirigid ureteroscopy was carried out immediately after. The ureteral stone was treated with Holmium laser and the fragments were actively removed using nitinol baskets. After having cleared out the ureter, a ureteral access sheath was inserted and a single-use flexible ureteroscope (LithoVueTM) was used to inspect the pelvicalyceal system. A percutaneous renal puncture was carried out under ultrasound and endovision control in a posterior lower calyx, looking for a transpapillary puncture. The tract was dilated up to 16Ch under endoscopic control. The different stones were treated using Holmium laser either through the rigid nephroscope and the flexible ureteroscope. Fragments were extracted through the Amplatz sheath, taking advantage of the “pass-the-ball” technique, with no residual fragments at the end. At the end of the procedure a double J stent was placed without nephrostomy tube, after having performed an endoscopic control of the percutaneous tract.

Clinical Case:

Age: 68
Gender: female
Weight: 68 kg
Height: 1.55 m
BMI: 28.3 kg/m2
Diagnosis: Left ureteric stone and multiple calyceal stones in the ipsilateral kidney

Clinical History:

Recurrent left renal colic. A double J stent was placed 2 months ago

Other:

No medical treatments
Previous surgeries: hysterectomy, sacral colpopexy
ASA score: II
Preoperative urine culture: positive (E. coli)
Preoperative treatment: amoxicillin (1 week prior to surgery)
Preoperative prophylaxis: amoxicillin + gentamicin

Procedure Steps:

OR setup and patient positioning for ECIRS (Galdakao-modified supine Valdivia position)
Semirigid ureteroscopy, lasertripsy and stone removal
Ureteral access sheath insertion and flexible ureteroscopy
Percutaneous puncture under ultrasound and endoscopic control (endovision)
Dilation of the percutaneous tract under endoscopic control up to 16Ch (miniPCNL)
MiniECIRS, holmium laser lithotripsy, “pass-the-ball” technique, and fragments removal
Drainages

Learning Points:

How to organize your OR for an ECIRS surgery in supine
Lasertripsy technique for ureteric stones
Tips and tricks for a combined ultrasound & X-ray guided puncture with endoscopic assistance (endovision puncture) in supine
miniECIRS technique and its advantages in multiple calyceal stone treatment
Drainage options: how and for whom?