Dean Knoll, M.D., is the Director of the Men’s Health Clinic and Prosthetic Urology for Urology Associates in Nashville, TN. Dr. Knoll received his medical degree from the University of Health Sciences, Chicago Medical School, North Chicago, Illinois. He completed an internship in general surgery and a residency in urology at the Mayo Clinic in Rochester, Minnesota. A frequent contributor to the medical press, Dr. Knoll has published over 100 peer-reviewed articles, abstracts and book chapters. He has delivered numerous lectures and operated both nationally and internationally. Dr. Knoll has been a principle investigator in over 110 basic science and clinical trials of new devices and pharmacotherapies for various urological diseases including for the diagnosis and treatment of male erectile dysfunction, male and female urinary incontinence, benign prostatic hypertrophy and Peyronie’s disease. In 1998, Dr. Knoll was the first urologist in the world to place a collagen graft derived from a pig’s small intestine into a penis to correct penile curvature from Peyronie’s disease. He has subsequently performed over 2,000 penile straightening procedures with grafting to manage penile curvature created by moderate to severe Peyronie’s disease. Dr. Knoll has performed over 7,000 penile implants and artificial urinary sphincters in his career. Dr. Knoll is a fellow of the American College of Surgeons and a diplomat of the American Board of Urology. He is also a member of numerous international and national medical organizations, including the American Urological Association, the International Society of Sexual Medicine and the Sexual Medicine Society of North America.
We report on a 47-year-old female patient with a history of macrohematuria and mild right flank pain. Urological evaluation by ultrasound and NCCT revealed a 17 mm stone in the right renal pelvis. The patient was referred to us for further treatment and the decision was made to perform a Mini PCNL. We demonstrate our technique of percutaneous access by combined ultrasound and fluoroscopy. After retrograde placement of a ureteral occlusion catheter the patient is turned onto a flat prone position. Dilation after puncture of the lower pole is done by means of a 16.5F single-step dilator and a 17.5F modified Amplatz Sheath is introduced. The stone can be visualized and is the disintegrated by the Lumenis Pulse 120H Holmium Laser with MOSES technology. The Moses technology is a unique technique patented by Lumenis. where the laser pulse is modulated to two sequences - the first one separates the water to create a small bubble, through which the remaining part of the energy travels to result in better energy transmission. It leads to higher dusting and fragmenting efficacy, significantly less retropulsion and eventually to faster procedures. Stone fragments are flushed out passively through the sheath. Flexible nephroscopy at the end of the procedure and contrast imaging confirm a complete stone-free status. A 14F nephrostomy is placed and the ureteral catheter is removed. The patient will be sent home on day 2.
With Lumenis
Published
Feb 2019
The surgical procedure was done via an infrapubic approach with a horizontal incision made 1 cm above the base of the penis. The reservoir was placed under direct vision by opening the tracts fascia in a horizontal manner and the rectified muscles separated in the midline. Transverse fascia then was opened and the reservoir was placed under the recti muscle. Corporotomy incisions were made on the dorsal aspect of the penis lateral to the identified cavernosal nerve bilaterally. After dilation, measurement and placement of the cylinders in each cavernosal body, the pump was placed in the most dependent portion of the right hemiscrotum lateral to the testicle and cord. The device cycled appropriately and good rigidity was demonstated and a 7 French flat JP drain was placed above the incision and placed alongside the pump.
With Boston Scientific
Published
Nov 2018
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