Ep. 197 Suction Devices in Urology: Improving Stone Removal with Dr. Roger Sur
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We know that TURBT procedure is critical in the care of patients with non-muscle invasive bladder cancer. With data that shows that CIS was missed by TURBT in more than 45% of radical cystectomy cases and 86% of residual tumors have been found at the original resection site, it's clear that enhanced visualization could be a significant benefit during TURBT's. Further, with only 23% of patients coming back for re-resection, it's all the more important to do a complete TURBT right from the start. This week on the Backtable Podcast. Isn't a stone a three-dimensional object? Shouldn't we be looking at volume of stone? You think about it, it totally makes sense. It's the volume of the stone that probably makes a lot more sense than the two-dimensional. It's kind of dumbing it down when really we should be looking at volume. So that I think is one of the futures is to look at
How much stone are you leaving behind? And not just in two dimensions, but in three dimensions. You can see there's emerging research demonstrating the importance of volume. So I think when you're gonna see that more and more, that people will be talking about how much volume is left behind and how that translates to all those things that you were talking about, post-op problems.
Hello, everyone, and welcome to Backtable, your source for all things urology. You can find all previous episodes on Apple, Spotify, YouTube, and on backtable.com. This is Aditya Bagrodia as your host this week. And I'm thrilled to invite our guest today, Dr. Roger Sir, who's one of my partners here at UC San Diego. He's a tremendous clinician, tremendous surgeon, great friend and partner. Roger, how's it going today?
It's going great, Aditya. I'm really honored to be here. And I'm glad you're my host, actually, because it makes it super comfortable for me since we're good friends.
Yeah, we are good friends. Roger's had the, I guess, pleasure or displeasure of helping me get my sea legs on a surfboard. So he's taken us out. It's been super fun. You know, one of the things I've been most impressed with getting to know Roger is it's the clinical care. It's the innovation, problem solving, remaining non-intimidated by new technologies. And maybe we'll get into that. So today we're going to talk about suction devices and suction technologies and kidney stone treatment. And I'm excited. You know, taking a walk down memory lane, largely it was lasers, fragment, basket retrieval for as long as that was required. Then dusting kind of came on the scene as like a new thing. And that seems to be kind of a...
ongoing debate in the minimally invasive endourology world. And then for PCNLs, it was like a cyber one, which was, I think, pulverized the stone and then somehow suctioned it up. Those were kind of the tools that I had in my toolkit, more or less. And maybe just ask you to kind of comment on, you know, what's transpired over the last decade or so. Well, actually, I was thinking about this upcoming podcast and just...
I thought maybe step back and give broad perspective to all of our audience because we've got some, you know, young people that are still in training. We have people recently out of training. We have people like yourself and myself that are, I guess, maybe mid-career working towards senior careers. And then there are people who've been around for quite some time. If we roll back the clock to the 70s and beyond, it was open surgery was phenomenal. you know, state of the art and really was the standard of care. But then somewhere in the 70s, three major players came in was the introduction of percutaneous stone surgery going through the back. And then the introduction of shockwave lithotripsy that really trying to change things because now we no longer had to
cut people or put things in people we just broke them up from the outside using acoustic energy and then came ureteroscopy first there were rigid devices and then we were able to introduce flexible devices and then flexible steerable devices so there's this constant migration and iteration of our technology and i would say for the past since that time there's those are the three players uh that are available to uh patients and depending on your
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