Medical expulsive therapy

Medical expulsive therapy can be offered as an initial treatment if pain is well-controlled, renal function is adequate, and sepsis is absent, Dr. Desai said. Persistent obstruction, a stone that is not passing, or increasing colic are indications for removal.

“Ninety-five percent of stones pass within the first four weeks; this is the cutoff we generally use when observation stops and treatment is indicated,” he said.

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Robotics: The future

An attempt to overcome these limitations has led to the introduction of robotics, said Dr. Desai. Investigators at Cleveland Clinic have worked on a flexible robotic catheter control system to perform flexible ureteroscopy. The robotic catheter system has instinctive control via a joystick. The tip of the sheath can be positioned in space at any time by control of the 3D joystick called the master input device.

After showing its feasibility in animal models, the robotic system was used to perform flexible ureteroscopy in 18 adult humans, 15 of whom had one stone each. On kidney, ureter, bladder radiography, stone clearance was 44% on postoperative day 1, 78% at two weeks, and 89% at three months; an ancillary ureteroscopic stone removal was required in one case.