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Revised Jan. 2016

Example of performing ECIRS

[ECIRS 01]

A staghorn stone including renal pelvis stone connected to midpole and lower pole stones, another upper pole stone. [left]
Another upper pole stone (12x11x11mm) with a narrow upper major calyx. [right]

[ECIRS 02]

Percutaneous puncture [prove versus supine]
I usually prefer supine to prone position. 

What is your option?
Usually prone and sometimes supine?
Usually psupine and sometimes prone?
Always supine? Always prone?

[ECIRS 03]

18Fr MPCNL removed stones in the renal pelvis and the lower pole stones. [left]
Remnant stones in the mid-anterior pole and the upper pole stone inaccessible by the nephroscope. [right] 

What is your option?
Postop ESWL? Additional percutaneous tracts? Flexible cysto/urethroscope?

[ECIRS 04]

Flexible cystoscopy insertion. Midpole stone fragmentation by flexible cystoscope but the upper pole stone was inaccessible by the flexible cystoscope because of the narrow upper major calyx.

[ECIRS 05]

RIRS was performed for the upper pole stone and completely fragmented.

[ECIRS 06]

Irrigation for complete stone-free status.

Example of performing PCNL + contralateral RIRS

Position for Rt. MPCNL

Position for Lt. RIRS

URS GW insertion for Lt RIR

Bladder drainage by urethral foley

Contrast injection into Rt ureter

Antegrade Ureteral catheter insertion into Rt.ureter

Antegrade superstiff GW insertion into bladder

Fascia dilator insertion into Rt renal pelvis

Rt safety terumo GW insertion into bladder

Two GWs insertions and dual lumen catheter insertion

Renal pelvis identification

Balloon dilator insertion

Ballooning and sheath insertion

Antegrade DJ catheter insertion

Antegrade DJ cath positioning and superstiff removal

Nephroscope insertion and balloon sheath positioning

Nephroscope insertion and DJ cath positioning

Laser fragmentation

Floseal insertion for hemostasis

Postop skin wound

Access sheath insertion for Lt RIRS

FURS and stone basketing

Stone Basketing

FURS insertion for Final Dusting

DJ insertion into Lt ureter

Postop KUB

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