Case presentation

Case presentation

Omar alhunaidi

Farwaniya Hosp.

history

33 year old Sudanese male, presented with:

lt loin pain

fever

CBC: leukocytosis

RFT: N

Urine R/M:

blood ++

leuk +++

Urine C/S: sent

KUB: lt staghorn

CT KUB

Emergency lt DJS was fixed

Isotope Scanning MAG 3 LEFT 39% Right 61%

Urine c/s was positive E. coli

Fever subsided after few days of IV Abx ( Tazo)

Discharged on oral Abx ( cipro for 2 wks)

Appointed for elective PCNL Vs. Open after 2 months

Pt chose open approach

Given Abx for 2 weeks prior to surgery “ Cipro”

Dissection revealed total intra-renal pelvis

Lt anatrophic nephrolithotomy

Cold ischemia time: 40 minutes

Total operative time: 3 hours

Blood loss <100 ml

follow up KUB: stone free

follow up renogram 76 % Rt kidneyand 24% left

• After 1 year, f/u KUB and Renogram were done

• KUB no ROS

• Renogram with split renal function was

• Rt 63%• Lt 37%

The AUA Panel identified four modalities as potential alternatives, on the strength of the evidence, for treating patients with staghorn calculi:

.1Percutaneous nephrolithotomy (PNL) monotherapy

.2Combinations of PNL and shock-wave lithotripsy (SWL)

.3SWL monotherapy; and

.4Open surgery – open surgical exposure of the kidney and removal of stones from the collecting system, typically anatrophic nephrolithotomy

STONE-FREE RATE

•PCNL 78% (74-83%)

•Combination 66% (60-72%)

•ESWL Monotherapy 54% (45-64%)

•Open Surgery 71% (56-84%)