Dr. Julie Riley

The danger zone is above 40, more or less, because that's where we start to see maybe some pylovenous backflow, and that might be where we're starting to get some of the infection risk. The problem that we have right now is for how long? Is that like a one-time burst? Is that a big deal? Or is it over a long period of time? So

The question is, if you give one shot and it goes up to 100, but for a half a second, quarter of a second, is that worse than if you maintained at 50 for five minutes? And none of us know the answer to that at this point. But there's no question if we don't measure it, we'll never know the answer to that.

The question is, if you give one shot and it goes up to 100, but for a half a second, quarter of a second, is that worse than if you maintained at 50 for five minutes? And none of us know the answer to that at this point. But there's no question if we don't measure it, we'll never know the answer to that.

The question is, if you give one shot and it goes up to 100, but for a half a second, quarter of a second, is that worse than if you maintained at 50 for five minutes? And none of us know the answer to that at this point. But there's no question if we don't measure it, we'll never know the answer to that.

I personally use a hand irrigation, so I do know that those certainly can generate a lot of pressure, but it gives me a lot of control with the instruments. And again, I'm training residents, so I'm usually with the hand pump, and I can manipulate the stones a little bit to help the residents be a little bit more successful with that and kind of keep some of that control of where the stone is.

I personally use a hand irrigation, so I do know that those certainly can generate a lot of pressure, but it gives me a lot of control with the instruments. And again, I'm training residents, so I'm usually with the hand pump, and I can manipulate the stones a little bit to help the residents be a little bit more successful with that and kind of keep some of that control of where the stone is.

I personally use a hand irrigation, so I do know that those certainly can generate a lot of pressure, but it gives me a lot of control with the instruments. And again, I'm training residents, so I'm usually with the hand pump, and I can manipulate the stones a little bit to help the residents be a little bit more successful with that and kind of keep some of that control of where the stone is.

I don't think that that is... written in stone that you have to do hand irrigation versus pressure irrigation versus gravity. I think all of those things serve their purpose. And if you're successful at any one of those things, do that. But I personally use hand irrigation.

I don't think that that is... written in stone that you have to do hand irrigation versus pressure irrigation versus gravity. I think all of those things serve their purpose. And if you're successful at any one of those things, do that. But I personally use hand irrigation.

I don't think that that is... written in stone that you have to do hand irrigation versus pressure irrigation versus gravity. I think all of those things serve their purpose. And if you're successful at any one of those things, do that. But I personally use hand irrigation.

Yeah, I think that there's a lot of discussion about this. And actually, this was some discussion that we had at the recent AUA. But I think stenting and coming back is obviously the safest thing to do. And I think you have to take into account a lot of patient factors in that. You may not have that much time to bring the patient back into the operating room.

Yeah, I think that there's a lot of discussion about this. And actually, this was some discussion that we had at the recent AUA. But I think stenting and coming back is obviously the safest thing to do. And I think you have to take into account a lot of patient factors in that. You may not have that much time to bring the patient back into the operating room.

Yeah, I think that there's a lot of discussion about this. And actually, this was some discussion that we had at the recent AUA. But I think stenting and coming back is obviously the safest thing to do. And I think you have to take into account a lot of patient factors in that. You may not have that much time to bring the patient back into the operating room.

They may have to wait quite a significant amount of time. So you may be more forced to push that a little bit more, particularly if you understand that the patient doesn't like stents, doesn't like the whole experience of stones, and you need to just get it done.

They may have to wait quite a significant amount of time. So you may be more forced to push that a little bit more, particularly if you understand that the patient doesn't like stents, doesn't like the whole experience of stones, and you need to just get it done.

They may have to wait quite a significant amount of time. So you may be more forced to push that a little bit more, particularly if you understand that the patient doesn't like stents, doesn't like the whole experience of stones, and you need to just get it done.

If it's a short, narrowed area, so less than two centimeters, I have no problem using a balloon to dilate up and then put the sheath in to allow access in that way to save an extra trip to the operating room. I think if it's a long, narrowed ureter, you are going to be kind of obligated to either put the flexible scope in, accept that you're going to have some higher pressures.

If it's a short, narrowed area, so less than two centimeters, I have no problem using a balloon to dilate up and then put the sheath in to allow access in that way to save an extra trip to the operating room. I think if it's a long, narrowed ureter, you are going to be kind of obligated to either put the flexible scope in, accept that you're going to have some higher pressures.

If it's a short, narrowed area, so less than two centimeters, I have no problem using a balloon to dilate up and then put the sheath in to allow access in that way to save an extra trip to the operating room. I think if it's a long, narrowed ureter, you are going to be kind of obligated to either put the flexible scope in, accept that you're going to have some higher pressures.

This is a great time to make sure that you get in, get out, be very efficient with your lasering, and really don't spend a lot of extra time looking around, doing things like that. Be very efficient with that. But if all else fails, stent and come back, even if the patient is really unhappy, the reality is you did the safe thing and you're avoiding some of this.