Ureteroscopy: Surgeons show techniques, tips in videos
Papillary grading system for patients with urolithiasis
Technologic improvements have allowed an unprecedented ability to see within the kidney during endoscopic stone treatment. There is increasing recognition that the renal papillae of stone-forming patients frequently have unique appearances. Appreciation of these papillary changes has potential to provide meaningful clinical information, but a standardized description of papillary appearance is necessary prior to exploring possible associations with clinical outcomes, according to Michael S. Borofsky, MD.
Dr. Ghani: While it is recognized that the appearance of the papilla in stone-forming patients may be variable, the significance of these changes is not well understood. Are patients with certain endoscopic appearances more likely to benefit from metabolic management, or more at risk for stone recurrence? Dr. Borofsky and his colleagues have created a very elegant instructional video that establishes a new papillary grading system for patients with nephrolithiasis. The system classifies papillary appearances based on the degree of plugging, pitting, loss of contour, and amount of Randall’s plaque. This endoscopic grading system may prove to be a useful clinical and research tool, and requires further validation and study.
Dr. Hotaling: Here, the authors describe a novel technique to classify renal papilla appearance during endoscopy. Widespread application of this system could allow sub-stratification of stone formers into different prognostic categories and help predict treatment outcomes as well as recurrence rates.
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