RESUMO
BACKGROUND Nephro-colic fistulas are uncommon, generally caused by local inflammation, trauma, or neoplasia affecting the kidney or the colon. Their association with a coralliform stone is described in a few case reports, but their management is difficult and differs quite a lot, depending on the clinical situation. We report an atypical clinical case of a reno-colic fistula associated with a staghorn calculus. This case adds to the literature an iconography rarely found. CASE REPORT A 68-year-old woman presented to the Emergency Department with respiratory symptoms and chronic abdominal pain. The biological results showed a high inflammatory syndrome. The radiological assessment revealed a retroperitoneal and left retro-renal abscess, attributed to a left nephro-colic fistula associated with the partial passage of a lithiasis within the colonic lumen. Colonoscopy confirmed the diagnosis. Multiple recurrences of diverticulitis in this region could be the origin of the complication. First, the patient was treated with antibiotic therapy and radiological drainage. Second, she benefited from a left nephrectomy, left segmental colectomy, and splenectomy. The clinical and radiological evolution were favorable after surgery. The follow-up was disrupted by hospitalizations in the Cardiology Department for cardiac decompensation. CONCLUSIONS Kidney stones along with local inflammatory phenomena can be the cause of a nephro-colic fistula. Due to the lack of guidelines in such cases, their diagnosis and management are difficult to ascertain. Surgery is the right course of treatment.
Assuntos
Abscesso Abdominal , Cólica , Fístula Intestinal , Cálculos Renais , Cálculos Coraliformes , Feminino , Humanos , Idoso , Cálculos Coraliformes/complicações , Cólica/complicações , Abscesso/complicações , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgiaRESUMO
BACKGROUND: The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare. CASE REPORT: The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.
Assuntos
Abscesso Hepático , Cálculos Coraliformes , Feminino , Humanos , Adulto , Cálculos Coraliformes/complicações , Cálculos Coraliformes/diagnóstico por imagem , Cálculos Coraliformes/tratamento farmacológico , Abscesso Hepático/tratamento farmacológico , Ultrassonografia , Antibacterianos/uso terapêutico , AmicacinaRESUMO
Fistula formation between the kidney, colon and the skin is an extremely rare complication arising from renal infections secondary to renal stone formation. During the 1980s, reports of nephrocolic fistulas, with or without involvement of the skin, were commonly caused by genitourinary tuberculosis. Due to improvements in diagnosis and specifically the development of anti-Koch's therapy, the incidence of nephrocolic or nephrocolocutaneous fistulas has become uncommon especially in developed countries.We report a case of a patient residing in a developing country, presenting with a 20-year history of a left flank lesion extruding minimal purulent output daily. He was seen at the emergency department due to weakness and was managed as a case of urosepsis. Contrast-enhanced CT scan and fistulogram showed a staghorn calculus in the left kidney with connections to the descending colon and skin. The patient eventually underwent a left hemicolectomy with en bloc excision of the kidney and fistula tract.
Assuntos
Cálculos Renais , Cálculos Coraliformes , Fístula Urinária , Masculino , Humanos , Cálculos Coraliformes/complicações , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Radiografia , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
BACKGROUND: Percutaneous nephrolithotripsy (PCNL) is difficult to perform for elderly patients; thus, this study aimed to assess its efficacy and safety in elderly patients aged > 70 years, note any associations between outcomes and patient characteristics, and summarize relevant themes and observations. METHODS: Data from patients older than 70 years who had undergone PCNL for upper urinary tract calculi between January 2016 and January 2021 was retrospectively analyzed. Risk factors for postoperative complications and residual stones were analyzed using multivariate logistic regression. RESULTS: A total of 116 elderly patients underwent 122 PCNL operations, of which six underwent secondary PCNL operations, and all of which were successfully completed. The average age was 74.6 ± 4.3 years; the average stone size and operation time were 3.5 ± 1.8 (1.2-11 cm), and 71.8 ± 34.1 min, respectively. Of the participants, 16 or 13.8% had postoperative complications and 29 (25%) had residual stones after operation. The stone free rate was 75%. Multivariate analysis revealed that an American Score of Anesthesiology III was an independent risk factor for postoperative complications (odds ratio [OR] = 4.453, p = 0.031), and staghorn calculi were independent risk factors for postoperative residual calculi (OR = 31.393, p = 0.001). CONCLUSION: PCNL was shown to be safe and effective for elderly patients aged > 70 years. Further, ASA III was an independent risk factor for postoperative complications, and staghorn calculi were independent risk factors for postoperative residual calculi in elderly patients.
Assuntos
Cálculos Renais , Litotripsia , Nefrostomia Percutânea , Cálculos Coraliformes , Idoso , Humanos , Estudos Retrospectivos , Nefrostomia Percutânea/efeitos adversos , Cálculos Coraliformes/complicações , Cálculos Coraliformes/cirurgia , Cálculos Renais/cirurgia , Cálculos Renais/complicações , Litotripsia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
Fistula formation between the kidney and the colon is a rare occurrence. Colorenal fistulas have been reported after renal cryoablation, calculous pyonephrosis, and renal cell carcinoma. Fistula formation is reported in as many as 35% of patients with Crohn's disease. Crohn's-related urinary fistulas may include enterovesical, enteroureteral, rectourethral, urethrocutaneous, and entero-urachal fistulas. Here, we report a rare case of a patient who was found to have a left colorenal fistula in the setting of a left staghorn calculus and recurrent urinary tract infections with a question about the eventual definitive management of the patient.
Assuntos
Doenças do Colo/cirurgia , Fístula Intestinal/cirurgia , Nefropatias/cirurgia , Cálculos Coraliformes/cirurgia , Fístula Urinária/cirurgia , Idoso , Doenças do Colo/complicações , Humanos , Fístula Intestinal/complicações , Nefropatias/complicações , Cálculos Coraliformes/complicações , Fístula Urinária/complicaçõesRESUMO
PURPOSE: To evaluate the outcomes of complete supine percutaneous nephrolithotomy (csPCNL) for staghorn stones and multiple large non-staghorn stones. METHODS: The records of 886 patients who underwent csPCNL from September 2009 to October 2019 were considered. Out of them, 201 cases met the eligibility criteria and they were divided into three groups: 63 cases of staghorn, 68 cases of multiple medium (20 mm < diameter ≤ 30 mm) non-staghorn and 70 cases of multiple large non-staghorn (> 30 mm) stones. Almost all outcomes and stone-related factors were analyzed. RESULTS: There was not any significant difference regarding age, body mass index, history of urinary tract infection, transfusion rate, complication rate, pre and post-surgery serum creatinine, hemoglobin drop and total hospital stay between the three groups. Stone free rate was 98.5% in multiple medium group, 97.1% in multiple large group and 84.1% in staghorn group (P = 0.001). The operation duration was significantly shorter for the multiple medium group (P < 0.001) but it was not significantly different between the multiple large non-staghorn and staghorn group. CONCLUSION: The results demonstrated that almost all outcomes were not significantly different between the three groups (especially between staghorn and larger non-staghorn ones). These findings reveal that surgeons could choose csPCNL for treatment of staghorn stones and multiple large non-staghorn stones and consider staghorn stones as challenging as multiple large (especially diameter > 30 mm) non-staghorn stones.
Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias , Cálculos Coraliformes , Decúbito Dorsal , Transfusão de Sangue/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Hidronefrose/diagnóstico , Hidronefrose/etiologia , Cálculos Renais/classificação , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Nefrotomia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Cálculos Coraliformes/complicações , Cálculos Coraliformes/diagnóstico , Cálculos Coraliformes/cirurgia , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologiaRESUMO
Obesity is a known risk factor for recurrent nephrolithiasis and it can be challenging to provide safe surgical intervention in the super obese population. Despite high weight limits on surgical beds, these often do not take into account positioning the patient on the end of the bed for dorsal lithotomy, which can risk an unsteady bed. In addition, depending on patient habitus the leg stirrups may not accommodate. There is limited literature that discusses the technical approach for positioning super obese patients in dorsal lithotomy when the weight limit approaches or exceeds the capacity of equipment available. In this article, we present a modified positioning technique to improve bed stability, which also provides an alternative if the patient's legs are not supported by available leg stirrups. From our experience, this modified dorsal lithotomy positioning for ureteroscopy is feasible and safe in patients with super obesity. Surgical intervention on this population requires appropriate planning and teamwork to ensure safe positioning.
Assuntos
Obesidade Mórbida/complicações , Posicionamento do Paciente/métodos , Cálculos Coraliformes/complicações , Cálculos Coraliformes/cirurgia , Ureteroscopia , Feminino , Humanos , Segurança do Paciente , Cálculos Coraliformes/diagnóstico por imagemRESUMO
A case is presented that demonstrates unusual long-term evolution of an infected calculi, culminating in the formation of a retroperitoneal abscess that fistulised to the pleural space, leading to a right pleural empyema.
Assuntos
Abscesso/etiologia , Empiema Pleural/etiologia , Cálculos Coraliformes/complicações , Infecções Urinárias/complicações , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Espaço RetroperitonealRESUMO
INTRODUCTION: Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more recent study found that conservative management was not as unsafe as previously believed. The present review sought to examine the available literature to understand the implications of a conservative strategy. METHODS: A systematic search of the literature was carried out using MEDLINE®, Embase™ and the Cochrane Central Register of Controlled Trials. All papers looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections, progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of relevant data, a descriptive review was carried out. RESULTS: Our literature search yielded 10 suitable studies involving a total of 304 patients with staghorn stones managed conservatively. Progressive renal deterioration occurred in 0-100% of cases (mean 27.5%) with a higher rate among bilateral staghorn sufferers (44% vs 9%). Dialysis was required in 9% of patients (20% bilateral, 6% unilateral). The mean rate of severe infection was 8.7% and recurrent urinary tract infections occurred in as high as 50% of cases (80% bilateral, 41% unilateral). Disease specific mortality ranged from 0% to 67% (mean 20.5%). CONCLUSIONS: It appears that conservative management of staghorn calculi is not as unsafe as previously thought and selection of patients with unilateral asymptomatic stones with minimal infection should be considered.
Assuntos
Tratamento Conservador/efeitos adversos , Insuficiência Renal/epidemiologia , Cálculos Coraliformes/terapia , Infecções Urinárias/epidemiologia , Tratamento Conservador/métodos , Humanos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Índice de Gravidade de Doença , Cálculos Coraliformes/complicações , Cálculos Coraliformes/mortalidade , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologiaRESUMO
RATIONALE: Although chronic pyelonephritis and urolithiasis are established risk factors for squamous cell carcinoma (SCC), only a minority of patients with chronic urolithiasis eventually develop SCC. It is believed that the chronic irritation leads to squamous cell metaplasia that may subsequently develop into SCC. Although studies show that SSC generally spreads locally with associated symptoms of lymphadenopathy, metastasis to the lungs and liver have also been reported. However, cases spreading to the flank have yet to be reported. Therefore, the use of reconstructive techniques for the repair of extensive soft tissue defects in the flank region after extended retroperitoneal resection, is unknown. PATIENT CONCERNS: We report a 54-year-old man who presented with a 1-month history of an enlarged skin mass on the right flank. DIAGNOSES: The patient was subsequently diagnosed with metastatic SCC involving the patient's integumentary system near the flank region proximal to the right kidney following percutaneous nephrostomy. INTERVENTIONS: The skin mass and the surrounding muscle tissue of the right flank were excised with a wide resection margin including radial nephrectomy. The soft tissue defect after resection was reconstructed using a unilateral gluteus maximus myocutaneous V-Y advancement flap. OUTCOMES: No recurrence of the SSC was found on follow-up CT performed 12 months postoperatively. LESSONS: In patients with long-standing nephrolithiasis complicated by staghorn stone-related infections, biopsies from suspicious lesions detected during percutaneous nephrolithotomy may facilitate early diagnosis. The modified gluteus maximus V-Y advancement flap may be a useful technique for the reconstruction of extensive soft-tissue defects involving the flank region.
Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Renais/patologia , Rim/patologia , Neoplasias Cutâneas/secundário , Cálculos Coraliformes/complicações , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Neoplasias Cutâneas/cirurgia , Cálculos Coraliformes/diagnóstico por imagem , Retalhos CirúrgicosRESUMO
PURPOSE: Metabolic disorders are common in patients with staghorn renal stones. Aim of this study was to evaluate and compare the metabolic disorders in patients with unilateral and bilateral staghorn stones. MATERIALS AND METHODS: In this cross sectional study, 78 patients who underwent percutaneous nephrolithotomy (PCNL) for staghorn renal stones were included. The urine volume, the level of calcium, oxalate, uric acid, phos-phate, sodium, citrate, creatinine, and cystine from 24 hour urine collection as well as the serum levels of calcium, phosphorus, magnesium, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH) and uric acid were recorded and compared among the two groups with unilateral and bilateral renal stones. RESULTS: 56 patients (71.8%) had unilateral and 22 (28.2%) had bilateral renal stones. At least one abnormal meta-bolic factor was found in 32 (57.1%) and 15 (68.2%) patients with unilateral and bilateral renal stones, respectively (P = .044). Cystine urine levels and serum levels of BUN were higher in cases with bilateral compared to unilateral renal stones (36.4% vs. 12.5%, P = .025 and 27.3% vs. 1.8%, P = .002, respectively). CONCLUSION: Metabolic factors are strongly correlated with the formation of staghorn renal stones specially bilat-eral ones. In our study among different metabolic factors, cystine urine levels and serum levels of BUN were sig-nificantly higher in patients with bilateral renal stones. Proper metabolic assessments are recommended in patients with staghorn urolithiasis.
Assuntos
Doenças Metabólicas/complicações , Cálculos Coraliformes/complicações , Cálculos Coraliformes/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Estudos Retrospectivos , Cálculos Coraliformes/cirurgiaAssuntos
Dor no Flanco/diagnóstico , Cálculos Coraliformes/diagnóstico por imagem , Cálculos Coraliformes/patologia , Adulto , Cistoscopia/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Serviço Hospitalar de Emergência , Dor no Flanco/etiologia , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Masculino , Nefrolitotomia Percutânea/métodos , Cálculos Coraliformes/complicações , Cálculos Coraliformes/cirurgia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgiaRESUMO
Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. The decision for optimal treatment of staghorn stones should be individualized according to the circumstances of the patient involved and in order to do so, a closer look at the advantages and disadvantages of each option is necessary.
Assuntos
Nefrolitotomia Percutânea/normas , Insuficiência Renal/prevenção & controle , Cálculos Coraliformes/terapia , Tomada de Decisão Clínica , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Terapia Combinada/normas , Tratamento Conservador , Feminino , Humanos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Recidiva , Insuficiência Renal/etiologia , Insuficiência Renal/mortalidade , Fatores Sexuais , Cálculos Coraliformes/complicações , Cálculos Coraliformes/diagnóstico , Cálculos Coraliformes/mortalidade , Resultado do TratamentoRESUMO
BACKGROUND: To describe the clinical characteristics, infectious and kidney function patterns, and overall outcomes in a cohort of patients with staghorn calculi treated conservatively. METHODS: Staghorn calculi treated nonoperatively between January 2009 and January 2017 were identified. A retrospective analysis was completed. RESULTS: Twenty-nine patients were identified with a median age of 74 years (interquartile range [IQR] 61-81). Mean follow-up was 24 months. Fifty-nine percent (17/29) had complete staghorn calculi with 6/29 (21%) bilateral. Mean body mass index was 29.4 (IQR 24.8-31.7). Of the 29 patients, 14 were treated conservatively due to comorbidities, 12 refused treatments, and 3 were due to aberrant anatomy. The age-adjusted Charlson Comorbidity Index (CCI) score demonstrated 8 patients in our cohort with a CCI of <3, 11 patients with a CCI of 4 or 5, 7 patients with a CCI of 6 or 7, and 3 patients with a CCI of >8. Overall, kidney function remained stable for 19/29 patients (66%) and the glomerular filtration rate decreased by <10% for 4/29 (14%), by 10%-29% for 2/29 (7%), and >30% for 4/29 patients (14%) over the study period. None of the study patients required hemodialysis. No patients in the cohort developed an abscess, nor were any patients on daily prophylactic antibiotics. There was only one related admission for a complication during the study; this was for pyelonephritis. There were two deaths during the study period. One death was an unrelated cardiac death and the other was from urosepsis; this patient had been noncompliant with follow-up. CONCLUSIONS: Outcomes for patients treated conservatively were reasonable in this select group. There is a need for future prospective studies to show whether conservative treatment of these patients is safe.
Assuntos
Tratamento Conservador/métodos , Rim/fisiopatologia , Cálculos Coraliformes/terapia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cálculos Coraliformes/complicações , Cálculos Coraliformes/fisiopatologiaRESUMO
A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. A conservative approach to its treatment may lead to high morbidity and mortality rates. Such morbidity usually manifests with renal failure, obstructed upper urinary tractand/or life-threatening sepsis. Prostatic abscesses have never been associated with staghorn calculi in the literature. We report a case of a 70-year-old man who presented with sepsis, which was found to originate from a complex prostatic abscess. The patient had no history of urinary tract infections or risk factors. The authors believe that the incidentally identified staghorn calculi promoted the growth of Proteus mirabilis which led to the development of the prostatic abscess. The patient underwent a transurethral resection and drainage of the abscess following a failed course of antibiotic therapy. This case also highlights the paucity of guidelines available in treating prostatic abscesses.
Assuntos
Abscesso/etiologia , Doenças Prostáticas/etiologia , Doenças Prostáticas/microbiologia , Infecções por Proteus/etiologia , Cálculos Coraliformes/complicações , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Humanos , Achados Incidentais , Pelve Renal , Masculino , Doenças Prostáticas/terapia , Infecções por Proteus/tratamento farmacológico , Proteus mirabilis/isolamento & purificação , Sepse/etiologia , Sepse/microbiologia , Cálculos Coraliformes/diagnóstico por imagem , Cálculos Coraliformes/microbiologia , Cálculos Coraliformes/terapia , Ressecção Transuretral da Próstata , Resultado do TratamentoRESUMO
A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed.
Assuntos
Anuria/etiologia , Hidronefrose/etiologia , Cálculos Coraliformes/complicações , Cálculos Ureterais/complicações , Obstrução Ureteral/etiologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Adulto , Creatinina/sangue , Humanos , Masculino , Ureter/patologia , Obstrução Ureteral/patologiaRESUMO
Prostatic parenchymal calculi are common in ageing men who are evaluated for benign prostatic hyperplasia or prostate cancer. Giant prostatic calculi are very rare, usually associated with local predisposing factors for urinary stasis and infections, and traditionally managed by open surgery. We present the first case of its kind to be associated with a concurrent staghorn nephrolithiasis, and removed successfully by endoscopic approach using an access sheath through the urethra.
Assuntos
Próstata/patologia , Doenças Prostáticas , Cálculos Urinários , Endoscopia , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Doenças Prostáticas/cirurgia , Cálculos Coraliformes/complicações , Cálculos Urinários/cirurgiaRESUMO
A 55-year-old male presented, in June 2013, with left flank pain. Investigations revealed a complete staghorn stone. He had undergone two sittings of extracorporeal shock wave lithotripsy (ESWL) in 2008 for left renal stone. One year subsequent to this, he was diagnosed with hypertension and diabetes. The management of complete staghorn stones in a single sitting is a difficult proposition. Percutaneous nephrolithotomy (PCNL) is the gold standard to manage such stones. The patient was subjected to PCNL, and complete clearance was achieved in one sitting. On one-year follow-up, there was a significant reduction in blood pressure (BP) and better glycemic control. Although there are several reports where hypertension has been reported after multiple sittings of ESWL, whether ESWL contributed to the genesis of hypertension and diabetes in this patient or it was simply incidental, cannot be stated with certainty. There was a significant reduction in the BP after complete stone removal, but there is uncertainty over the effect of total clearance of renal stones on hypertension, and we need to await the results of more controlled trials studying this phenomenon. A better glycemic control was perhaps achieved secondary to the eradication of recurrent urinary tract infections due to complete stone clearance.
Assuntos
Pressão Sanguínea , Hipertensão/fisiopatologia , Nefrolitotomia Percutânea , Cálculos Coraliformes/cirurgia , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus/sangue , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Cálculos Coraliformes/complicações , Cálculos Coraliformes/diagnóstico por imagem , Resultado do Tratamento , UrografiaRESUMO
Renal stone disease may present as nephrocutaneous fistula. Spontaneous extrusion of renal stone with nephrocutaneous fistula is rare. Most of the cases have been reported in adults. We present a case of nephrocutaneous fistula with spontaneous extrusion of staghorn renal calculus in a paediatric patient.