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1. Introduction
1.1 Key words
2. Radiographic Evaluation
3. The Acute Stone Episode: Indications for Intervention
3.1 History and Physical Examination
3.2 Laboratory Studies
3.3 Radiographic Evaluation
3.4 Pain Control
3.5 Management of Obstructive Pyelonephritis
3.6 Medical Expulsive Therapy
4. Shock Wave Lithotripsy
4.1 Shock Wave Physics
4.2 Comminution Mechanisms
4.3 Design of Lithotripters
4.3.1 Electrohydraulic Generator
4.3.2 Electromagnetic Generator 
4.3.3 Piezoelectric Generator
4.4 Imaging
4.5 Indications and Contraindications
4.6 Adjunctive Procedures
4.7 Acute Complications
4.7.1 Renal Injury
4.7.2 Steinstrasse
4.7.3 Hypertension
4.7.4 Diabetes
4.7.5 Renal Impairment
4.8 Special Considerations
4.8.1 Pediatrics
4.8.2 Renal Ectopia
4.8.3 Fusion Abnormalities
4.8.4 Obesity
4.8.5 Reproductive Concerns
5. Percutaneous Nephrolithotomy
5.1 Indications
5.2 Preoperative Considerations
5.3 Percutaneous Access
5.4 Access size
5.5 Stone Extraction
5.6 Drainage
5.7 Postoperative Management
5.8 Complications
5.8.1 Urosepsis
5.8.2 Hemorrhage
5.8.3 Visceral Injury
6. Semi-Rigid Ureteroscopy
6.1 Indications
6.2 Operative Considerations
6.3 Complications
6.3.1 Perforation
6.3.2 Avulsion
6.3.3 Infection/Sepsis
6.3.4 Stricture
7. Flexible Ureteroscopy
7.1 Indications
7.2 Operative Technique
7.3 Complications
8. Open/Laparoscopic/Robotic Stone Surgery
8.1 Anatrophic Nephrolithotomy
8.2 Pyelolithotomy
8.3 Caliceal Diverticulolithotomy
8.4 Ureterolithotomy
8.5 Nephrectomy
9. Intracorporeal Lithotripsy Devices
9.1 Laser Lithotripsy Technologies
9.1.1 Holmium Laser
9.1.2 Thulium Fiber Laser
9.2 Electrohydraulic Lithotripsy (EHL)
9.3 Ultrasonic Lithotripsy (UL)
9.4 Pneumatic Lithotripsy
9.5 Combination Devices
10. Selection of Therapy
10.1 Renal Calculi
10.1.1 Staghorn Calculi
10.1.2 Non-Staghorn, Non-Lower Pole Renal Calculi
10.1.3 Lower Pole Renal Calculi
10.2 Ureteral Calculi
References
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Surgical Treatment

Editors:
Marcelino E. Rivera, MD
Authors:
Austen Slade, MD
Last Updated:
Thursday, January 20, 2022

1. Introduction

The prevalence in stone disease has increased over the last two decades to afflict nearly 9% of the U.S. population.1 While prevention is the cornerstone of patient management, when patients do present with symptomatic urolithiasis they require appropriate surgical management. Constant improvement in endoscopic technology has led to a change in the recommended management for stone disease. Therefore, this Core Curriculum will discuss the surgical management of urolithiasis, from the initial diagnosis of an acute stone event to surgical management in the patient requiring intervention.

1.1 Key words

Shock wave lithotripsy, Ureteroscopy, Percutaneous Nephrolithotomy

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