PAEA Surgery End Of Rotation (EOR) Practice Exam

Which option is specifically used for symptomatic large pelvic stones removal?

1. Percutaneous Nephrolithomy

2. Ureteroscopy

3. Extracorporeal Shock Wave Lithotripsy

4. Open Surgery

The correct answer is: Percutaneous Nephrolithomy

Symptomatic large pelvic stones typically require a more invasive approach for removal due to their size and associated complications. Percutaneous Nephrolithotomy (PCNL) is specifically designed for the management of large renal stones, often exceeding 2 cm in size, and it allows for direct access to the kidney through a small incision in the back. During PCNL, a nephroscope is inserted, enabling the clinician to visualize and fragment the stone directly, which is then removed. This method is particularly effective for large pelvic stones given its ability to handle significant stone burden and its advantage in providing immediate access to the stone, reducing complications associated with prolonged obstruction or infection. Other methods like ureteroscopy are typically more suited for stones located within the ureter or smaller stones in the kidney, and while Extracorporeal Shock Wave Lithotripsy (ESWL) can be used for stones that are not too large or obstructive, it may not be as effective for larger stones due to the need for adequate stone fragmentation. Open surgery, despite being a viable option, is usually reserved for very complex cases or when other less invasive measures have failed. Thus, PCNL stands out as the preferred approach for symptomatic large pelvic stones.