COMPLETE STONE CLEARANCE PACKAGE AT RAMAYYAS PRAMILA HOSPITALS: LEFT PCNL AND RIGHT ESWL IN THE FIRST SETTING FOLLOWED BY RIGHT RIRS FOR CLEARANCE OF RESIDUAL FRAGMENTS

A 65 year old lady came with left partial staghorn calculus; bulk mainly in upper calyceal group.There was a calculus of around 2 cm in right middle calyx and right renal pelvis. Her urine culture was positive for klebsiella and creatinine level was 3 mg%. Our nephrologist started the patient on imipenam group of the drug and advised to delay surgery for 72 hours till culture was sterile for the safety of the surgery and avoid post operative flare of the infection.

She was taken up for right DJ stenting and left PCNL. Her left ureter was kinked at the PUJO and so could not pass ureteric catheter beyond the PUJO. We punctured the system by stone guided method and introduced micro-nephroscope to ensure right entry into the calyceal system. After ensuring the good access ; a guide wire was placed and dilatation was carrioed out till 24 Fr and Amplatz sheath was introduced and stone fragmentation was don with pneumatic lithotripsy. A complete clearance was achieved and 5 FR DJ stent was placed antegradely at the end of the PCNL procedure.

USE OF MICROPERC TO ENSURE ENTRY INTO DESIRED CALYX

Her post operative stay was uneventful and marked by steady decline in the values of serum creatinine till 1.3 mg%. She was taken up for ESWL right side after a period of 2 weeks.there was a good fragmentation and clearance of the calculus .After further 2 weeks , we took patient up for secondary RIRS and the residual calculi were also cleared.

WE ENSURE COMPLETE CLEARANCE OF THE CALCULI AND ROUTINELY DO IMAGING -CT SCAN AND START METABOLIC WORK UP AND PREVENTIVE MEASURES FOR PREVENTING FUTURE RECURRENCE.WE ARE EQUIPPED WITH STATE OF THE ART EQUIPMENTS TO ENSURE COMPLICATION FREE SURGERIES FOR THE SAME.