Percutaneous Nephrolithotomy: From Access to Exit

Course directors:
Arthur Smith, MD
Ralf V. Clayman , MD

Zhamshid Okhunov
Nikolay Grigorev
Kam Kaler
Thomas Tailly 

Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for large kidney stones. Despite technological advancement and refinements in surgical techniques, PCNL remains one of the most challenging procedures. Technical challenges with renal access and concerns over morbidity of the operation due to a lack of familiarity and ability to troubleshoot challenges or complications may lead surgeons to avoiding PCNL when it is the ideal surgical approach to a stone. At this didactic course, two pioneers of Endourology, Dr. Arthur Smith and Dr. Ralph Clayman will share their knowledge on tips and tricks for a successful PCNL.

Learning objectives:

  • Optimal patient selection for URS, SWL and PCNL procedures
  • Review of imaging modalities and planning for PCNL
  • Patient positioning and instrumentation for PCNL
  • Perform prone flexible cystoscopy
  • Recognize and manage complications of PCNL
  • Tips and tricks for fluoroscopy guided, endoscopic and ultrasound guided percutaneous access to the kidney
  • Apply knowledge gained in this course to develop a practice in which PCNL becomes an integral surgical procedure in the treatment of stone disease





1pm – 1:10pm

Welcoming & Introductions

Arthur Smith
Ralph Clayman

1:10 – 1:25pm

Basic Requirements and Positioning for PCNL

Zhamshid Okhunov

1:25 – 1:40pm

Fluoroscopically guided prone Percutaneous Access

Evangelos Liatsikos

1:40 – 1:55pm

Endoscopically guided Access for PCNL

Ralph Clayman

1:55 – 2:10pm

Ultrasound guided Access for PCNL

Nikolay Grigorev

2:10 – 2:25pm

Tract Dilation: tips and tricks

Thomas Tailly

2:25 – 2:40pm

Stone Removal and Lithotripsy

Kam Kaler

2:55 – 3:10pm

Flexible nephroscopy

Kam Kaler

3:10 – 3:25pm

Difficult access: Tips and tricks

Arthur Smith

3:25 – 3:40pm

AUA Surgical guidelines for Stone treatment

Zhamshid Okhunov

3:40 – 3:55pm

Exit strategies

Nikolay Grigorev

3:55 – 4:10pm

Follow up recommendations and stone prevention

Ralph Clayman

4:10 – 4:25pm

Complications of PCNL

Evangelos Liatsikos

4:25 – 5:00pm

Panel discussion: Difficult Cases

Arthur Smith,

Ralph Clayman




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