HYDRONEPHROSIS SINISTRA ET CAUSA PARTIAL STAGHORN CALCULI OBSTRUCTION SINISTRA Devyana E.Taslim 1 , Marta Hendry 2 1 Clinical Senior Cleckship, School of Medicine, Medical Faculty of Sriwijaya University, Dr.Mohammad Hoesin General Hospital, Palembang 2 Department of Urology, School of Medicine, Medical Faculty of Sriwijaya University, Dr.Mohammad Hoesin General Hospital, Palembang Background Obstruction is one of the most important abnormalities of the urinary tract, since it eventually leads to decompensation of the muscular conduits and reservoirs, back pressure, and atrophy of the renal parenchyma. It also invites infection and stone formation, which is cause additional damage and can ultimately end in complete unilateral or bilateral destruction of the kidneys. Complete obstruction leads to rapid decompensation of the system proximal to the site of obstruction. Partial obstruction leads to gradual progressive muscular hypertrophy followed by dilatation, decompensation, and hydronephrotic change. Hydronephrosis is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys. Hydronephrosis (kidney swelling) occurs as the result of a disease. It is not a disease itself. Conditions that are often associated with unilateral hydronephrosis include: Nephrolithiasis (kidney stones). A kidney stone, also known as a renal calculus, is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter
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Obstruction is One of the Most Important Abnormalities of the Urinary Tract
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HYDRONEPHROSIS SINISTRA ET CAUSA PARTIAL STAGHORN CALCULI OBSTRUCTION SINISTRA
Devyana E.Taslim 1, Marta Hendry 2
1Clinical Senior Cleckship, School of Medicine, Medical Faculty of Sriwijaya University, Dr.Mohammad Hoesin General Hospital, Palembang2Department of Urology, School of Medicine, Medical Faculty of Sriwijaya University, Dr.Mohammad Hoesin General Hospital, Palembang
Background
Obstruction is one of the most important
abnormalities of the urinary tract, since it
eventually leads to decompensation of the muscular
conduits and reservoirs, back pressure, and atrophy
of the renal parenchyma. It also invites infection
and stone formation, which is cause additional
damage and can ultimately end in complete
unilateral or bilateral destruction of the kidneys.
Complete obstruction leads to rapid
decompensation of the system proximal to the site
of obstruction. Partial obstruction leads to gradual
progressive muscular hypertrophy followed by
dilatation, decompensation, and hydronephrotic
change.
Hydronephrosis is the swelling of a kidney
due to a build-up of urine. It happens when urine
cannot drain out from the kidney to the bladder
from a blockage or obstruction. Hydronephrosis
can occur in one or both kidneys. Hydronephrosis
(kidney swelling) occurs as the result of a disease.
It is not a disease itself. Conditions that are often
associated with unilateral hydronephrosis include:
Nephrolithiasis (kidney stones).
A kidney stone, also known as a renal
calculus, is a solid concretion or crystal
aggregation formed in the kidneys from dietary
minerals in the urine. Urinary stones are typically
classified by their location in the kidney
(nephrolithiasis), ureter (ureterolithiasis), or
bladder (cystolithiasis), or by their chemical
composition (calcium-containing, struvite, uric
acid, or other compounds). About 80% of those
with kidney stones are men.
Kidney stones typically leave the body by
passage in the urine stream, and many stones are
formed and passed without causing symptoms. If
stones grow to sufficient size (usually at least 3
millimeters (0.12 in)) they can cause obstruction of
the ureter. Ureteral obstruction causes postrenal
azotemia and hydronephrosis (distension and
dilation of the renal pelvis and calyces), as well as
spasm of the ureter. This leads to pain, most
commonly felt in the flank (the area between the
ribs and hip), lower abdomen, and groin (a
condition called renal colic). Renal colic can be
associated with nausea, vomiting, fever, blood in
the urine, pus in the urine, and painful urination.
Renal colic typically comes in waves lasting 20 to
60 minutes, beginning in the flank or lower back
and often radiating to the groin or genitals. The
diagnosis of kidney stones is made on the basis of
information obtained from the history, physical
examination, urinalysis, and radiographic studies.
urinary tract infection from the job of the patient
and partial staghorn stone obstruction. From the
anamnesis, physical examination, laboratory, BNO
finding this patient has been diagnosed of
hydronephrosis sinistra e.c partial staghorn stone
obstruction sinistra. The most suitable treatment for
this patient is ureterorenoscopy URS sinistra and
pyeloletotomy sinistra. Beside medication and
surgery patient should also be given proper
education before surgery. Patient should be
educated about to change of lifestyle could
improving the quality of living. Firstly reeducation
of fluid intake at specific times, recommended total
daily fluid intake is 2L per day. Secondly, take
some exercise so that every part of the body can
work properly. Third, control to the doctor as the
scheduled.
Conclusion
This case report we found that the patient chief
complain was pain at the hip. From the anamnesis
we can conclude that he feel pain when he lifted a
heavy thing, after take a long sit, pain at the rear
side, pain radiate to the lower spine, done less
activity, less drink water, but there is no pain when
urination, no bleeding, no continuous urine. From
the physical examination i found that CVA region
there was tenderness, palpable enlargement of
kidney, but from the external genitalia theres no
abnormality. From the lab test there was slightly
increase at the erithrosit, calcium, and creatinine.
From the BNO we can see the opaque stone at the
left pelvic area. From the information it has
presented upper tract symptom along with physical
rectal examination and BNO which point to see the
obstruction that cause by staghorn stone at the renal
pelvic. Further investigation of pathology and
anatomy using BNO to confirm the diagnosis of the
hydronephrosis. Later to that, this patient had to
undergo nefrolitotomy. Following surgical
treatment, patients may be seen within 2 weeks to
discuss the histological findings and to identify
early post – operative morbidity. Long term follow
up should be scheduled at 3 months to determine
final outcome.
Reference
1. Preminger, GM (2007). "Chapter 148: Stones in the Urinary Tract". In Cutler, RE. The Merck Manual of Medical Information Home Edition (3rd ed.). Whitehouse Station, New Jersey: Merck Sharp and Dohme Corporation.
2. Wolf Jr. JS (2011). "Background". Nephrolithiasis. New York: WebMD. Retrieved 2011-07-27.
3. Purnomo, Basuki B (2009). Dasar-Dasar Urologi edisi II. Falkutas Kedokteran Universitas Brawijaya
4. Soeparman (1990). Ilmu Penyakit Dalam. Jilid II. FKUI. Jakarta
5. Purnomo, Basuki B (2012). Dasar-Dasar Urologi edisi II. Falkutas Kedokteran Universitas Brawijaya
6. Curhan, G. C.; Willett, W. C.; Rimm, E. B.; Spiegelman, D.; Stampfer, M. J. (Feb 1996). "Prospective study of beverage use and the risk of kidney stones". Am J Epidemiol 143 (3): 240–7. doi:10.1093/oxfordjournals.aje.a008734. PMID 8561157