Richard E. Link, MD, PhD, presented “A Better Mousetrap: Minimally-Invasive Management of Symptomatic Caliceal Diverticular Stones in the Era of Robotic Surgery” virtually during the Innovations in Urologic Practice 2020 virtual conference in September 2020.
How to cite: Link, Richard E. “A Better Mousetrap: Minimally-Invasive Management of Symptomatic Caliceal Diverticular Stones in the Era of Robotic Surgery” September 26th, 2020. Accessed Nov 2024. https://dev.grandroundsinurology.com/a-better-mousetrap-minimally-invasive-management-of-symptomatic-caliceal-diverticular-stones-in-the-era-of-robotic-surgery/
Summary:
Richard E. Link, MD, PhD, Professor of Urology and the Carlton-Smith Endowed Chair in Urologic Education at the Baylor College of Medicine, discusses the pros and cons of different techniques for managing caliceal diverticular stones, a simple problem requiring a complex solution. The presentation aims to provide a framework for the identification and management of this condition since there are not enough high-quality studies to have a definitive strategy. Dr. Link discusses caliceal diverticulum incidence, etiology, and presentation, as well as the specific qualities of stones in caliceal diverticula, noting that stone formation is not caused by the presence of a caliceal diverticulum, but rather by the same metabolic anomalies experienced by other stone formers. He then dissects the different surgical options for treatment, including: extracorporeal shockwave lithotripsy (ESWL), which results in stone-free rates of ≤25% and should only be used in patients who cannot tolerate more effective therapy; ureteroscopic management, which is superior to ESWL but still has low success rates; and percutaneous management, which was the gold standard treatment before the era of robotic surgery, and results in a stone-free rate between 70 and 100%, although it can be a challenging surgery. Dr. Link also discusses laparoscopic diverticulectomy and robotic true partial nephrectomy, more aggressive approaches that may be needed if percutaneous management fails. He concludes with several case studies, emphasizing that treatments should be tailored to individual patients.
About the Innovations in Urologic Practice 2020 virtual conference:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Crawford presented this talk virtually at this year’s conference.
ABOUT THE AUTHOR
Richard E. Link, MD, PhD, Professor of Urology and the Carlton-Smith Endowed Chair in Urologic Education at the Baylor College of Medicine (BCM) in Houston, Texas, is a Board-certified and fellowship-trained urologist specializing in the treatment of urologic disease affecting the kidneys, ureter, and prostate. He focuses on the use of laparoscopic, robotic-assisted, percutaneous, and endoscopic techniques to treat kidney tumors, renal and ureteral obstruction, and urinary tract stones. He directs the BCM Division of Endourology and Minimally Invasive Surgery and is active nationally in teaching these techniques to other urologists through the American Urological Association Office of Education. He has also directed the BCM fellowship program in Minimally Invasive Urologic Surgery since 2008. He is the recipient of several awards specifically recognizing his commitment to teaching and mentoring, including two Fulbright and Jaworski LLP Faculty Excellence Awards (Teaching and Evaluation and Development of Enduring Materials) and several Resident Teaching Awards.
Dr. Link has been an early pioneer in the development of laparoendoscopic single-site donor nephrectomy. He serves as Director of Living Donor Procurement for several major kidney transplant programs in Houston, including
CHI/SLEH/BCM, Texas Children’s Hospital, and the Houston Methodist Hospital.
Dr. Link completed his PhD in Molecular and Cellular Physiology at Stanford University, CA. His research laboratory studies the genetic basis for renal cell carcinoma disease using a combination of genetically engineered mouse models, stem cell biology, and sophisticated whole genome molecular techniques. His clinical research interests include surgical simulation, decision analysis modeling, and the application of 3D reconstruction and printing techniques to surgical education.
