．Speaker．

Dr. Pai-Fu, Wang

Chief of the Uro-Oncology Center, Changhua Christian Hospital

Speaker's Biography:

Dr. Pai-Fu Wang is the chief of the Uro-Oncology Center of Changhua Christian Hospital. His career as a urologist started at Veterans General Hospital in 1988, and he has more than 30-year clinic experience. He is also one of the pioneers who perform minimally invasive surgeries and robotic-assisted surgeries in Taiwan.

Dr. Wang's main clinical and academic interests include Extracorporeal Shock Wave Lithotripsy (ESWL), Minimally Invasive Urological Surgery, and Urologic Oncology; He has published many papers in leading journals such as the International Journal of Surgery, Journal of Endourology, and Asian Journal of Surgery.

Topic:

General Practice of Urolithiasis Management at Changhua Christian Hospital

Abstract :

Urolithiasis can be classified by etiology, composition, size, location, or image characteristics. The possibility of recurrence is associated with the underlying clinical disease. The risk factors of urolithiasis formation include early-onset (in children or adolescents), apparent family history, Brushite (CaHPO4. 2H2O) stone, hyperuricemia (uric acid stone), infected stone, hyperparathyroidism, metabolic syndrome, and miscellaneous medical/anatomical abnormality.

The initial evaluation should be focused on thorough history taking, physical and laboratory examination. Imaging study could be individualized with sonography, plain KUB, intravenous urography, non-contrast (or contrast) CT scan, and MRI (for the pregnant). Stone analysis and metabolic evaluation are not mandatory for all. For pain management, non-steroid anti-inflammatory drugs (NSAID, e.g., diclofenac, indomethacin, ibuprofen, or other COX-2 inhibitors) are preferred firstly. The role of antimuscarinics is controversial, but certain alpha-blocker was proved to be effective for small lower ureteral stones expulsion. Surgical intervention is always necessary for the relief of obstructive uropathy and severe colic. Infection with or without obstructive uropathy could be an emergent condition. Urine collection for bacterial culture after relief of obstruction is crucial for antibiotics guidance.

Extracorporeal shockwave lithotripsy, ESWL, is now the easiest way of stone fragmentation. The success rate is highly correlated with the lithotripter's efficiency, stone size, and stone location. Contra-indications of ESWL are rare but should be cautious with the pregnant, the anti-coagulated (or with bleeding tendency), uncontrolled urinary tract infection, morbid obesity, or those with bony/vascular abnormality. Ureterorenoscopy, URS, can be performed by retrograde rigid ureteroscopy, or antegrade/retrograde approach by flexible ureterorenoscopy (fURS), so-called retrograde intrarenal surgery (RIRS). Stone fragmentation can be performed with a pneumatic lithotripter or laser energy, such as holmium: yttrium-aluminiumgarnet (Ho:YAG) laser.

Bleeding should always be taken seriously as an important issue for percutaneous nephrolithotomy, PCNL. Stopping anticoagulant/antiplatelet drugs or correction of bleeding tendency before the operation is critical. Contra-indications of PCNL include uncontrolled urinary tract infection, tumor over the surgical route, possible renal cancer, and pregnancy. PCNL can be performed in the supine or prone position. Usually, the smaller size of nephroscopy would harbor fewer complications from tract intervention. The tubeless technique (without post-operative nephrostomy tube) can be applied for uncomplicated cases.

Slide and Additional Information:

Link: https://reurl.cc/YOrpLX