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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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