In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Jason Wynberg, director of endourology at NYU Langone Health in Brooklyn, about his percutaneous nephrolithotomy (PCNL) technique and innovations.

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SHOW NOTES

First, Dr. Wynberg explains his workup for a potential PCNL patient. He considers stone size, stone density, preexisting comorbidities, and patient preferences. He uses CT scans, retrograde pyelograms, and flexible ureteroscopy to study the anatomy of the patient. Next, he explains how he gets his own access through retrograde access while the patient is in the supine position.

Then, he discusses the trademark patent he currently holds for a PCNL kit, which includes a puncture wire, sheath, and coaxial microintroducer. The kit allows urologists to put a retrograde puncture wire through a flexible ureteroscope. He notes that this kit decreases renal trauma and allows the papillary puncture to be aligned with the infundibulum. He also reflects on the challenges of developing his kit and finding industry partners to support development. Although he had to wait 7 years to commercialize his technology, he saw the prolonged time as a benefit because he was able to improve its design before commercial release.

Finally, he explains his technique for using the PCNL kit and offers advice for different difficult scenarios during PCNL. He emphasizes that, in the end, skilled surgeons ensure the success of PCNLs, not just the equipment they use.

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