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Ureteroscopic Surgery for Stones: How to Avoid or Manage Complications

Hours: 1.25

Best suited for: Urologists

Course Description
You are beginning a ureteroscopy on a male patient with a 6mm impacted mid-ureteral calculus when unexpectedly, you encounter difficulty in gaining access proximal to the stone.  Do you know all of your options at this critical point?
 Access to the ureter, impacted stones, and careful follow up of complicated cases are paramount to resolving ureteral calculi and to preventing the loss of renal units. In this webinar, Dr. Gerhard Fuchs, an internationally recognized expert in the treatment of stone disease, reviews his safe and proven techniques in the treatment of renal and ureteral calculi.  Through illustrations and case examples he discusses safe access to the ureter, how to negotiate impacted stones, treatment of renal pathology, and how to manage complications when they occur.

Learning Objectives
Urologists who complete this course will be able to:
  1. Access the ureteral site of pathology while minimizing traumatic risks to the ureter.
  2. Describe the process for selecting the appropriate equipment that will also be cost effective in stone treatment.
  3. Explain how they determine when to refer patients to tertiary level expert intervention.
  4. Image patients appropriately postoperatively based on their original pathology and extent of surgical intervention.

Additional Resources for Members and Subscribers

In her 2018 review of this online course, Van Ginger, MD, notes an article by Ahn et al. showing that urologists do not do nearly enough postoperative imaging (about 55%, with 39% of patients not having postoperative imaging at 3 and 12 months out). Of the postoperative imaging done, most were x-ray KUBs which would not show hydronephrosis. In fact, in a series by Manger et al., 9.3% had hydronephrosis postoperatively.


1. Ahn JS, Holt SK, May PC, Harper JD. National Imaging Trends after Ureteroscopic or Shock Wave Lithotripsy for Nephrolithiasis. J Urol. 2018 Feb;199(2):500-507. doi: 10.1016/j.juro.2017.09.079. Epub 2017 Sep 21.
2. Manger JP, Mendoza PJ, Babayan RK, Wang DS. Use of renal ultrasound to detect hydronephrosis after ureteroscopy. J Endourol. 2009 Sep;23(9):1399-402. doi: 10.1089/end.2009.0392.

Faculty Information
Gerhard J. Fuchs, MD, is Professor of Clinical Urology and Executive Director of the University of Southern California Institute of Urology in Beverly Hills.  He also serves as Director, Center of Men’s Health, Director of Education, and Director of Quality Assurance at the USC Institute of Urology. An internationally renowned surgeon, researcher, and educator with nearly 30 years of experience, Dr. Gerhard J. Fuchs specializes in minimally invasive procedures for treating kidney stones, advanced endoscopic, and urologic laparoscopic surgery. He is Board Certified through the American and German Boards of Urology, and is a Fellow of the American College of Surgeons.

Planning Group
Ernest Sussman, MD, VP, SCRUBS Risk Retention Group, Stuart, FL, Urology, Las Vegas, NV
T. Spark Corwin, MD, Western Washington Medical Group, Department of Urology, Everett, WA
Celia Smith, CHCP, Director of Continuing Medical Education, Physicians Insurance
Mesina McMurray, Content Development Project Manager, Physicians Insurance
Neil Vasquez-Solis, Risk Management Education Assistant, Physicians Insurance

CME Information:
This CME activity was planned and produced in accordance with the ACCME Essentials.
Category 1 credit is applicable throughout the United States.
Estimated time to complete this activity:  1.25 hour

Physicians in Washington who complete this course will fulfill the risk management education requirement mandated by the Washington Health Services Act of 1993.

Physicians Insurance/Experix is accredited by the Washington State Medical Association to provide continuing medical education for physicians.
Physicians Insurance/Experix designates this internet enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity meets the criteria for up to 1.25 hours of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.


All faculty, planning and peer-review group members have certified that neither they nor their spouses/partners have, nor have had within the past year, any financial arrangements or affiliation with any commercial organization involved in the health care goods or services consumed by or used on patients, with the exemption of non-profit or government organizations and non-health care related companies.

Resolution of Conflicts of Interest
Physicians Insurance/Experix has implemented a process to resolve conflicts of interest for each continuing medical education activity, to help ensure content objectivity, independence, fair balance, and content that is aligned with the interest of the public. Conflicts, if any, are resolved through a peer-review process.

Member and Subscriber Access
Interested in a CME program like this for your team or facility? Contact us to schedule it and talk about pricing.

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Original release: April 2016
Last reviewed: April 2018
Expiration: April 2019

This course is offered through Experix, a wholly owned subsidiary of Physicians Insurance, and is based on more than 30 years' experience in providing continuing medical education. This course is complimentary for Physicians Insurance members.

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