Update: Interventional imaging in upper urinary tract stone disease

17 March 2013

Today’s Plenary Session provided a complete picture of the latest developments regarding the upper urinary tract. Co-chaired by former Scientific Congress Office Chairman Prof. Freddie Hamdy and current Congress President Prof. Francesco Montorsi, the session featured distinguished speakers from Europe and beyond.

Speaking on the role of extracorporeal shock wave lithotripsy (ESWL), Dr. Mahesh Desai (IN) former SIU President and former President of the Urological Society of India, presented the SIU lecture on the role of ESWL in upper urinary tract stones.

Drawing on his experience at the Muljibhai Patel Urological Hospital, Desai spoke in great detail on the differences between European and Indian hospitals’ approaches to treating kidney stones. For instance, percutaneous nephrolithotripsy (PCNL ) accounted for 41% of treatment in India, compared to 7% for European hospitals. The difference in stone composition accounts for this.

“Of course, world-wide we all want the best result for our patients. However, in India we have economic considerations as well,” said Desai.
Desai outlined what he called “Booster Therapy,” an early re-treatment 48 hours after the initial ESWL session. This secondary treatment is targeted at upper urinary tract stones which have not fragmented well as indicated by imaging with ultrasound and X-ray. “Booster therapy significantly decreases the complications associated with ESWL,” Desai explained.

“It seems best suited for stones that are bulky and more resilient to fragmentation. Prospective randomised studies are required to confirm this observation,” he added.

Update on interventional imaging
Dr. Cesare Scoffone (IT) gave an overview of new techniques in image-guided therapy. New tools were the “all-seeing needle,” image-guided renal puncture and computer-assisted surgery. The audience was very interested to see the use of iPads in the operating room. It can be used as a camera, as a computer to send and receive data wirelessly and, most impressively, as a way to show a virtual anatomy. Based on the CT scan, 3D images can be projected onto the patient’s anatomy in real time by the use of coloured markers.

“We hope that technological advances, when applied to clinical practice can solve many problems and make our procedures more effective and safer,” Scoffone concluded.