Francis X Keeley Jr
Foreward by Demetrius H Bagley
The practical application of Endourology is totally instrument dependent. None of the procedures is dependent only on the use of a knife and sutures. Similarly, the successful use of these instruments is dependent on the techniques employed. It is fitting then to have a book which gathers the “Top Tips” that experienced endourologists find valuable.
The success of procedures depends on the selection of the instruments for the appropriate situation and then for their appropriate application. Among the contributions to this book, there is not a single instrument that must always be used in a defined situation and then there is not a single technique for its application. There are preferences for many different reasons, among them the endourologist’s experience with a device and seemingly small differences between similar instruments.
My choice of a working instrument is usually the device which is first developed that can do the job in the specific circumstance. I tend not to change to another manufacturer’s design unless there is some significant beneficial change over the original device. But it is important to try new devices in search of that significant improvement.
It is important to beware of the rules of Never and Always. These are subject to change and modification. An excellent example of this is that the recommendation never to use a basket to retrieve a stone from the kidney ureteroscopically has changed with basket design. It is quite true that it can be dangerous to use a stainless steel basket to retrieve stones from the kidney since it may become impacted irreversibly in the ureter with a fragment too large to remove. However, nitinol baskets can be used quite safely since they can almost always release their stone burden. There are numerous other examples that make one wary of never and always.
This book is a collection of short essays from numerous authors throughout the world who offer tips that may be in disagreement in some cases. However, each proponent has the basis and experience to report those specific views. Each of us can gain from reviewing specific tips from others’ experience and consider applying them in the appropriate clinical situation.