Daron Smith

‘Mini, ultra, micro’ – nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy (PCNL) techniques

New minimally invasive percutaneous nephrolithotomy (PCNL) techniques have changed the management of renal stones. We discuss the technological advances in PCNL and explain the meaning, requirements and set up costs for each of these ‘newer’ techniques.

Contemporary Management of Stone Disease: The New EAU Urolithiasis Guidelines for 2015

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Tips and tricks of ureteroscopy: consensus statement Part I. Basic ureteroscopy

DIFF] n this month’s issue of European Urology, two major components of the European Association of Urology guidelines are summarised regarding the diagnosis and management and the interventional treatment of urolithiasis [1,2]. [9_TD

The British Urology Researchers in Surgical Training (BURST) Research Collaborative: an alternative research model for carrying out large scale multi-centre urological studies

DIFF] he [10_TD

BONES AND STONES

DIFF]low [11_TD

A Multi-Centre Cohort Study Evaluating the Role of Inflammatory Markers in Patient's Presenting With Acute Ureteric Colic (MIMIC)

DIFF]level of evidence for[12_TD

A pilot study to assess the utility of a freely downloadable mobile application simulator for undergraduate clinical skills training: a single-blinded, randomised controlled trial

DIFF] many of the reference statements [13_TD

Importance of citrate and the calcium : citrate ratio in patients with calcium renal lithiasis and severe lithogenesis.

DIFF]demonstrates the paucity of highquality randomised [14_TD

Percutaneous Nephrolithotomy and Spina Bifida – Complex Major Stone Surgery?

DIFF]trials available in stone disease, making this expert consensus all the more important for guiding current practice. The diagnostic guidelines are clear. Although ultrasonography is the primary diagnostic tool, it remains user dependent, with a range of sensitivities from 19% to 93%. Noncontrast computed tomography scan (NCCT) is the standard for investigation of acute flank pain, with dosereduction techniques offering high sensitivity (97%) and specificity (95%). Radiation exposure reference ranges are given, demonstrating that low-dose NCCT achieves similar doses to kidney, ureter, and bladder x-ray (0.97–1.9 vs 0.5– 1.0 mSv). Computed tomography (CT) scanning also allows assessment of Hounsfield units (HU), which may be helpful in planning treatment; the guidelines suggest that >1000 HU are less likely to be fragmented with shockwave lithotripsy (SWL). An aspect not addressed is the potential for dual-energy CT to assess stone composition. This type of technology may be helpful in the future not only for directing surgical therapy but also for identifying stones suitable for medical dissolution with alkalinising agents. Diagnostic imaging in pregnancy is a challenging situation, and ultrasound remains the imaging method of choice, with magnetic resonance imaging as a second-line option, but these updated guidelines now include low-dose CT scanning as the final option in selected cases.

Antibiotics and ureteroscopy: a single prophylactic dose is enough, but could we give even less?

Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an “expert consensus view” from experienced endourological surgeons, on all aspects of basic ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy. In this paper we provide a summary of treatment planning, positioning, cannulation of ureteric orifice, guidewire placement, rigid ureteroscopy and stone fragmentation.