Laparoscopic transmesocolic pyelolithotomy in an ectopic pelvic kidney.
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Management of large calculi in ectopic pelvic kidneys poses a challenge to the urologist. Risk of injury to surrounding abdominal viscera and vasculature makes open surgery as well as percutaneous nephrostolithotomy in an ectopic kidney a challenging procedure. Laparoscopic management avoids open surgery and associated morbidity and offers added safety. We report the management of symptomatic stones in a pelvic ectopic kidney lying anterior to the L5 vertebra and sacrum by transmesocolic laparoscopic pyelolithotomy in an 11-year-old child. Complete stone clearance was achieved with no complications and an uneventful postoperative recovery. The patient was discharged 72 hours after the surgery. (+info)
Spontaneous rupture of the left renal collecting system during pregnancy.
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Spontaneous rupture of a normal renal collecting system during pregnancy is uncommon and all reported cases have occurred in right kidneys. We report a case of spontaneous rupture of the left renal collecting system during pregnancy. A 33-year-old pregnant woman presented with left loin and lower abdominal pain, and signs of preterm labour, at 32 weeks' gestation. An emergency caesarean section was performed for foetal distress but the left loin pain did not subside after delivery. Ultrasonography and a computed tomogram showed a left perinephric collection and urine extravasation, compatible with rupture of the renal collecting system. A percutaneous nephrostomy was inserted and the symptoms subsided. A summary of the literature discussing management of this clinical situation is provided. (+info)
Urinothorax: an unusual cause of pleural effusion.
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Urinothorax refers to the presence of urine in the pleural space secondary to obstructive uropathy, and is an unusual cause of pleural effusion. The importance of recognising this entity lies in the fact that the condition is completely reversible following relief of urinary tract obstruction. We describe a 35-year-old man who developed urinothorax following a percutaneous nephrolithotomy for renal calculi. We also reviewed the literature for reported cases between 1968 and 2006. (+info)
Percutaneous nephrolithotomy of kidney calculi in horseshoe kidney.
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INTRODUCTION: The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in horseshoe kidneys with calculi. MATERIALS AND METHODS: Between 1995 and 2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there was a single calculus and the rest had multiple calculi in the pelvis and at least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and intravenous urography (IVU) were performed in all patients. We used fluoroscopy for entering the system and then, pneumatic or ultrasonic lithotripsy was used. RESULTS: In all except 1 patient (88.9%) we could access the system. Single calculi in 3 patients were removed. In 5 patients with multiple calculi, the calculus causing obstruction was removed, and in 3, the calculi located in the calyxes were removed too. Consequently, 66.7% were stone-free at the end of the procedure. In 2 patients, there were residual calculi in the calyxes and they underwent candidates for extracorporeal shockwave lithotripsy. CONCLUSION: Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the patient selection is appropriate and the surgeon is experienced enough. The success rate and complications are the same as the patients with normal anatomy. However, access to the lower calyx is more difficult due to its anatomic status. (+info)
Paradoxical air embolism during percutaneous nephrolithotomy: a case report.
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Air embolism is a rare complication of percutaneous nephrolithotomy. Patent foramen ovale, which is necessary in fetal circulation, is a potential route for emboli arising from the venous system to enter the systemic arterial circulation, resulting in paradoxical air embolism syndrome. A case of paradoxical air embolism during percutaneous nephrolithotomy is presented. To our knowledge, this is the first report of paradoxical air embolism associated with patent foramen ovale during percutaneous nephrolithotomy. (+info)
Contemporary practice of percutaneous nephrolithotomy: review of practice in a single region of the UK.
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Radiation safety issues in fluoroscopy during percutaneous nephrolithotomy.
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INTRODUCTION: Fluoroscopy-guided intervention during percutaneous nephrolithotomy (PCNL) has become the order of the day. During this procedure, both the patient and the physician are exposed to some radiation. Measurement of radiation doses in patients and personnel are important. Patient radiation doses are used for comparison with other centers for achieving the best possible radiation practice. In addition, there are performance checks for the fluoroscopy machines so that x-ray emitting machines should work at the optimum level ie, producing good images at minimum possible radiation doses. MATERIALS AND METHODS: This is a review of literature and discussion on radiation dose to patients and personnel, and on basic radiation safety tenets and their application in urological interventions of PCNL procedure. RESULTS: Radiation doses during PCNL have gone down over the time due to advances in technology. However, as radiation is hazardous, there is no room for complacency. A hospital's medical physicist may ensure even further reduction of x-ray dose by carrying out regular dosimetry and quality assurance tests on the fluoroscopy machines. A survey meter may provide an easy and quicker but not-so-accurate method for occupation exposure determination. CONCLUSION: The practice of PCNL procedures seems to be quite safe with radiation point of view. The quick, easy, and economical method of estimation of radiation dose using survey meter may need further calibration with the standard thermoluminescence dosimetry method. Setting optimum x-ray parameters, incorporation of filters, and quality assurance tests are a few areas where medical physicists may help in further reduction of radiation doses. (+info)
Percutaneous nephrolithotomy in patients with solitary kidney.
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INTRODUCTION: The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in the patients with solitary kidneys. MATERIALS AND METHODS: Between 1995 and 2005, we had 11 patients with a solitary kidney and kidney calculi who underwent PCNL at our center. Tubeless and standard PCNLs were performed in 3 and 7 patients. In 1 patient, we could not achieve access to the system due to the stricture of the infundibulum. RESULTS: The calculi were extracted or fragmented successfully in 10 patients. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 week after the procedure, which was treated conservatively. Also, fever occurred in 3 patients after the procedure which was treated successfully. The patients were discharged on the 3rd and 4th postoperative days. CONCLUSION: Although PCNL is accompanied by the risk of complications such as severe bleeding that may result in kidney loss in patients with a solitary kidney, the rate of success and complications seem to be similar to the other patients if careful operation and correct selection of candidates are done. Therefore, we recommend cautious performance of PCNL in patients with solitary kidneys. (+info)