039IC - Optimization of Technological Advancements in Ureteroscopy and Related Instrumentation

Course Description: Ureteroscopy is a widely utilized treatment option for nephroureterolithiasis, upper tract neoplasms and strictures. Over the last three decades, there have been progressive improvements in both ureteroscope design as well as ancillary equipment in an effort toto maximize surgical effectiveness while minimizing treatment morbidity. More recently, we have seen multiple new advances including single-use flexible ureteroscopes, enhanced laser technology capable of producing extremely small resultant stone fragments, and irrigation systems designed to remove small stone fragments and improve visibility. As the limits of these technological advancements are being observed, safety and cost considerations must be critically evaluated. The practical challenge for the contemporary endourologist is understanding the role of all this new technology in order toto achieve safe and effective patient outcomes while being a good steward of operating room resources. This instructional course will provide the learners with exposure to newly available ureteroscopes and ancillary devices in the context of treatment of upper tract stone disease, upper tract neoplasms and upper tract obstructions. Any and allAll published data on outcomes using these new modalities will be critically reviewed as well as general cost considerations. Special attention will be given to safety aspects of the new technology as well as avoidance of potential complications. .

Learning Objective 1: Critically evaluate available laser technologies including high-powered holmium, thulium fiber lasers and others and know the role for each in terms of stone treatment, upper tract tumor ablation and stricture incision.

Learning Objective 2: Better define laser setting parameters based on fundamental definitions of laser physics such as peak power, pulse duration, energy and frequency in order to independently judge the safety and effectiveness of suggested pre-settings provided by industry partners for both thulium and holmium lasers.

Learning Objective 3: Identify which patients with upper urinary tract urothelial carcinoma are appropriate for conservative ureteroscopic treatment and understand when to apply adjuvant therapies such as intraluminal medications and systemic treatments.

Learning Objective 4: Describe fundamental principles of intrarenal pressure during ureteroscopy and appreciate the possible resultant clinical implications. Recognize the balance that needs to be achieved between safe intrarenal pressure and adequate ureteroscopic visualization.

Learning Objective 5: Define fundamental ureteroscope design and function for both flexible and semi-rigid instruments and understand the advantages and disadvantages of fiberoptic and digital models in both reusable and single-use versions.

Learning Objective 6: Detrmine the utility, value and limitations of ureteroscopes and ureteral access sheaths capable of active and passive evacuation of resultant stone fragments during laser lithotripsy.

Learning Objective 7: Recall the multiple existing classification systems for complications involving ureteroscopy and identify which patients are high risk for complications during ureteroscopy and work towards minimizing these risks.

Learning Objective 8: Optimize retrograde ureteral access for ureteroscopy in challenging clinical scenarios including as adjuvant to antegrade percutaneous or laparoscopic approaches.