BILATERAL SIMULTANEOUS PCNL IN A BILATERAL STAGHORN CALCULUS

A 42 year old gentleman came with bilateral staghorn calculus in a normally excreting kidneys on IVP.

He didn't have any comorbidities and was symptomatic only for left side.His hematological and biochemical parameters were normal.

We did bilateral simultaneous PCNL for the patient.The surgery was uneventful and the post-operative imaging is awaited but on the table there was complete clearance. 

The treatment of bilateral urinary calculus disease is often staged, irrespective of the modality of the treatment. Bilateral simultaneous percutaneous nephrolithotomy (PCNL) is still considered by many to be adventurous and risky.But we feel in a young patient with no comorbidties and spacious calyceal system especially upper calyceal dilatation we can chose to do bilateral PCNL. 

We undertake PCNL in a side where the kidney function is better or patient is symptomatic then if the PCNL completes uneventfully without any bleeding and with complete clearance then such a subset of the patients; we go for second side  PCNL.

We usually keep nephrostomy to have a re look after a peiod of 24-48 hours allowing oedema to settle and also allowing patients post-operative reactions like fever to subside.