Predicting the outcome of mini percutaneous nephrolithotomy using STONE nephrolithometry score-a single-center experience.

To predict stone-free and complication rates following mini-percutaneous nephrolithotomy (m-PCNL) using STONE nephrolithometry score, this prospective observational study was conducted in the Department of Surgery, Urology Unit, Patan Hospital. All the patients undergoing m-PCNL were included. The cases were performed in the prone position, a single tract less than 18 French was made, and pneumatic lithotripsy was done. Stone-free rates were assessed with plain X-ray kidney, ureter, and bladder (X-ray KUB) on the first post-operative day or at 15 days follow-up. Complications within 30 days were graded using modified Clavien grading. A total of 106 patients were included in the final analysis. The overall stone-free rate was 83%. Among the individual variables, only staghorn calculus was associated with residual stone (p = 0.007). Patients who were rendered stone-free had statistically significantly lower STONE scores than those with residual stone (p < 0.001). The complication rate was 23%, and the majority were Clavien grade I complications. A higher STONE score had a greater risk of having complications but was not statistically significant (p = 0.11). STONE nephrolithometry score can predict stone complexity pre-operatively and subsequent stone-free status and thus, helps in pre-operative surgical planning and counseling for possible outcomes following m-PCNL.

Forgotten DJ stent presenting with emphysematous pyelonephritis: A life threatening complication.

INTRODUCTION: Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue. CASE PRESENTATION: We report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done. CLINICAL DISCUSSION: This case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management. CONCLUSION: Emphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated.