Patient With Multiple Renal And Ureteric Calculi

A 38 year old patient presented with pain in the left flank and fever of 15 days duration.He was a known case of renal stone disease having undergone Percutaneous Nephrolithotomy(PCNL) 5 years back on the same side.

On investigations there were with multiple left renal calculi bulk mainly in lower and middle calyceal groups and multiple lower ureteric stones .He was treated with suitable antibiotic medications till his Urine culture became sterile.
He was then taken up for Ureteroscopy first in view of making him free of ureteric obstruction.With Holmium LASER lithotripsy all stones were pulverised and a 5.5 Fr DJ stent was placed.

Ater a period of 2 days; he was taken up for conventional PCNL.The access was done through posterior-inferior calyx and middle posterior calyx. The complete fluoroscopic and endosocpic clearance was achieved with the use of LASER lithotripsy.

With availability of Holmium LASER as energy medium for stone pulverisation the dwell time in ureter and pelvi-calyceal system has been reduced greatly.It gives us freedom for initially going for Ureteroscopy and rapid stone clearance instead of PCN placement which is done conventionally in Febrile UTI with stones.Thus many complicated stone patients can be tackled in minimun possible sittings without compromising on safety.