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    Difficult stones present treatment, training challenges

    Michael Wong, MDMichael Wong, MDThe difficult stone case presents a challenge to the clinician—a challenge that requires considerable knowledge and experience to tackle, according to Michael Wong, MD, medical director and senior consultant of the Urology, Fertility, and Gynecology Center at the Mount Elizabeth Hospital in Singapore. In this interview, Dr. Wong describes difficult stones, discusses the skills and training required to treat them, and outlines the role of different treatment modalities. Dr. Wong was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, the Uehling Professor and founding chairman of the department of urology at the University of Wisconsin, Madison.

    Please briefly discuss your background in urology and stone disease.

    My interest in urology and stone disease in particular started when I experienced my first ureteric colic 25 years ago. At that point in time, I was in a hepatobiliary residency. After the passage of stones, I decided I should do urology. I had the privilege of being Dr. Jim Lingeman’s fellow in 1994. After this fellowship, I returned to Singapore and have spent 22 years in an academic institution and 8 years in a private institution.

     

    What is a difficult stone?

    The biggest category of difficult stones in our practice consists of high-volume staghorn stones. We see a lot more staghorn stones in Asia than in most parts of the world. The other category of difficult stones consists of those that reside in abnormal kidneys, such as pelvic stones.

     

    Who do you think should be treating the difficult stone?

    It should be someone who has a subspecialty interest and who is trained in this area, so an endourology fellow would probably be the best person to handle these kinds of stones.

    Next: What type of experience would a typical endourology fellow have to make them suitable for these kinds of surgeries?

    Stephen Y. Nakada, MD
    Stephen Y. Nakada, MD, a Urology Times editorial consultant, is professor and chairman of urology at the University of Wisconsin, Madison.

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