Urinary tract full of stones

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Urinary tract full of stones

  1. 1. Urinary tract full of stones Ranjit pandey ranjitpandey17@gmail.com Cist college,Ktm +977-9849464685
  2. 2. Introduction  Mr. K S  31 years/male, driver  Kalanki  Chief complaint : pain in the left flank 1 wk back  DOA : 063/8/14
  3. 3. HOPI  1 wk back sudden attack of pain in the left flank and back colicky and radiating downwards to the groin associated with one episode of vomiting  Went to TUTH and diagnosed as having renal stone  No h/o frequency, burning micturition haematuria and fever  Passing stool normally  Smoker, 10-12 sticks per day, drinks alcohol occasionally
  4. 4. On examination  Average build, normal nutritional status  Afebrile,  PR : 96/min  BP : 110/90 mmHg  RR : 20/min  Pallor , icterus and edema absent  Chest : NAD, Heart : NAD  P/A : tender in left lumbar region on deep palpation
  5. 5. Investigations  Hb 13.9 gm%  WBC 9700/cmm (N75%, L19%,E4%)  B+ve  RBS 85 mgm%  Urea 35 mgm%  Creatinine 1.3 mgm%  Calcium 10.6 mgm%  Phosphorus 4.1 mgm%
  6. 6. Contd  Urine R/E WBC 2-3 RBC 12-15  Urine C/S : No growth  IVU : Bilateral multiple renal calculi left ureteric calculi at proximal part Right kidney normally excreting but left kidney delayed excreting
  7. 7. mgmt  Operated on 063/8/15  Operation Left pyelolithotomy left ureterolithotomy left URSL and DJ stent  Post op findings left hydronephrotic kidney two large calculi in intra-renal pelvis multiple calculi in ureter at different level
  8. 8. Procedure - left Morison's incision - pyelotomy made and stone removed - ureterotomy made and 4 stones retrieved - 2 impacted stones confirmed by URS - lithotripsy done from above for 1 calculus - DJ stent kept but could not proceed to bladder - URS performed from below and stone removed - DJ stent in bladder confirmed
  9. 9. Contd  Put on I/V fluids tab paracetamol, tab ibuprofen inj gentamicin  Post op : uneventful  Discharged on 4th post op day  On F/U visit : doing well
  10. 10. Thank you

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