Postoperative Renal Abscess Following Tip-Flexible Suctioning Ureteral Access Sheath and Digital Ureteroscopic Lithotripsy: A Case Report.

BACKGROUND The tip-flexible suctioning ureteral access sheath (TFS-UAS) can be bent under flexible ureteroscopes, which facilitates removal of renal stone segments by irrigation and suctioning effects. Small-scale comparative studies found it safer and more efficacious than traditional UAS. However, complications such as renal abscess were not documented after TFS-UAS combined with digital FURS. CASE REPORT A 57-year-old woman had right lumbar pain that persisted for 1 year. A plain computed tomography (CT) scan revealed multiple renal pelvicalyceal stones (maximum diameter 20×9 mm). She was admitted to undergo elective surgery with a TFS-UAS combined with digital flexible ureteroscopic lithotripsy. The operation was deemed successful and she was given postoperative antibiotics for 2 days before discharge. Eight postoperative days later, she was admitted to the emergency department due to high fever (39.6°C). Plain CT revealed intact double-J stents and no abnormalities. She was readmitted to the urological department to receive antibiotic therapy, which progressed to septic shock (blood pressure 80/50 mmHg) and required immediate transfer to the intensive care unit. Contrast-enhanced CT revealed a right renal abscess. She was promptly resuscitated and given stronger antibiotics. She recovered well and was discharged with 2-week oral levofloxacin treatment. Follow-up ultrasound found no renal abscess. CONCLUSIONS While TFS-UAS with digital FURs is an effective approach for multiple renal stones, there is a risk of postoperative renal abscess, possibly due to altered intrarenal pressure.

Preliminary experience with lost mini percutaneous nephrostomy channel retrieval by methylene blue injection.

Percutaneous nephrolithotomy (PCNL) is the primary choice for managing large renal stones and the establishment of mini-/micro-channels has been increasingly gaining practice. The smaller the channel, the easier it is to be lost, which may require a new puncture site and increase the risk of bleeding complications. In this study, we retrospectively reviewed 1,056 PCNL procedures in our single institute, The University of Hong Kong - Shenzhen Hospital, between March 2014 and August 2023. Twenty-three cases of nephrostomy channel loss during mini PCNL were identified, resulting in an incidence rate of 2.2%. Methylene blue was immediately injected into the ureteral catheter to facilitate location and retrieval of the channel. Once extravasation of the dye was identified under rigid ureteroscope, a first guidewire was introduced into the channel for maintenance, followed by another guidewire inserted in parallel to facilitate dilatation. The major reasons for PCNL channel loss were mild hydronephrosis and complete obstruction of the target calyx due to renal stones. Technical success, defined as the ability to retrieve the lost channel within 5 minutes, was 78.3% (n=18/23). Three channels were completely lost and 2 patients showed channel bleeding despite successful identification, all of which required establishment of a new PCNL channel. No major intraoperative nor postoperative complication was observed.

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report.

Background: Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large renal stones. However, multi-tract or staged procedures may be necessitated in bilateral or anatomically-complex stones to achieve stone clearance. Endoscopic combined intrarenal surgery (ECIRS) integrates the advantages of PCNL and retrograde intrarenal surgery. In this article, we detail a hybrid surgical technique adopted for the management of complex simultaneous bilateral upper urinary tract stones. In addition, we discuss the advantages and disadvantages of combining a variety of new techniques that may improve post-operative outcomes and patient satisfaction. Case Description: We report the case of a 36-year-old male with a large left renal pelvis stone, right proximal ureteric stone, and bilateral renal stones. Biochemical results showed raised inflammatory markers but he denied pre-stenting and staged surgery. After receiving 3-day antibiotic prophylaxis, he underwent an elective hybrid procedure. Under split-leg prone position, we performed a hybrid procedure that included left ECIRS with tubeless single-tract mini PCNL and left flexible ureteroscopy, and right flexible ureteroscopic lithotripsy. Hemostasis was achieved by electrocauterization with a novel device. The patient made an uneventful recovery. Follow-up computed tomography (CT) at 1-month revealed complete stone clearance. Conclusions: Unilateral ECIRS with tubeless single-tract mini PCNL with electrocoagulation hemostasis and adjacent retrograde intrarenal surgery in split-leg prone position is a safe, feasible, and efficient technique to manage large renal stones.

Flexible ureterolithotripsy for the management of multiple gas-containing renal calculi: A case report and literature review.

Gas-containing renal stones (GCS) are rare urological entities. Current literature has suggested possible associations with premenopausal women, urinary tract infection, and metabolic diseases. We report the case of a 25-year-old young woman with no underlying co-morbidities who had multiple right GCS and suspected emphysematous pyelitis. Antibiotic therapy was initiated to control her urinary tract infection with E. coli. She then underwent elective right flexible ureteroscopy to relieve her ureteropelvic junction obstruction. Complete stone retrieval was achieved and she made an uneventful recovery with no stone recurrence during 1-year follow-up.

Incidental Finding of Intrarenal Foreign Guidewire During Percutaneous Nephrolithotomy: A Case Report and Literature Review.

BACKGROUND Percutaneous nephrolithotomy (PCNL) is indicated for large renal calculi (≥2 cm) and is often the treatment of choice due to its high success rate. Guidewire fragmentation is a rare procedural accident that can occur in PCNL but may be missed. Retention of the fragment within the upper urinary tract can lead to further complications, such as recurrent nephrolithiasis or impairment of renal function. CASE REPORT We present the case of a 54-year-old man who experienced right flank pain for 5 days. His history was significant for recurrent nephrolithiasis, managed by PCNL in other hospitals. The most recent procedure was conducted 4 years ago, and his perioperative course was uneventful. Preoperative computed tomography revealed right renal calculi and a C-shaped foreign body. He was scheduled for an elective PCNL. The foreign body was intraoperatively identified as a guidewire fragment and removed. CONCLUSIONS Currently, there is no standard management for intrarenal foreign bodies. Suspicion should be raised in young patients with recurrent stones within a short period of time. A thorough history on past urological interventions should be obtained. Symptoms can also have an insidious onset that could mimic nephrolithiasis or urinary tract infections. Extraction can be done via a standard minimally invasive approach. It is also the surgeon's responsibility to check the integrity of intraoperative instruments so as to minimize risks of complication and reassure the patient.

A Patient with Fragmentation of a Calcified Ureteric Stent Requiring Ureteroscopy and Laser Lithotripsy.

BACKGROUND Encrustation of the ureteral stent is a common complication that occurs after a prolonged indwelling duration. Other identified risk factors in the literature include urinary sepsis, chemotherapy, chronic renal failure, metabolic or congenital abnormalities, and nephrolithiasis. This report presents the case of a 39-year-old man with nephrolithiasis and fragmentation of a calcified right ureteric stent that required ureteroscopy and laser lithotripsy. CASE REPORT A 39-year-old man was initially admitted for ureteroscopy and laser lithotripsy after the diagnosis of bilateral urolithiasis. Ureteral stents were placed. One postoperative month later, the patient returned for follow-up and stent withdrawal. Follow-up computed tomography revealed a normal left kidney, intact bilateral ureteral stents, and residual right renal stones. However, an attempt to completely withdraw the stent failed and the patient had to undergo a secondary right ureteroscopy with laser lithotripsy. The fragmented proximal section of a calcified right ureteral stent with occluded lumen was found intraoperatively and sent for product analyses. After successful reintervention, the patient had a new right ureteral stent placed, which was successfully withdrawn during his next follow-up. CONCLUSIONS Ureteral stent encrustation may occur earlier than anticipated, possibly due to underlying patient risk factors. Complications, such as fragmentation of the ureteral stent, may occur during withdrawal. Physicians should be aware of any predictors for early ureteral stent encrustation to prevent unnecessary reintervention.