| Autor: |
Jain, Nitesh, Shukla, Ketan, Desai, Ketan D., Shah, Shrenik J., Khan, Altaf, Sachar, Rajesh |
| Předmět: |
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| Zdroj: |
Indian Journal of Urology; Supplement1, Vol. 24, pS31-S31, 1/3p |
| Abstrakt: |
Introduction: Shock wave lithotripsy over the past 25 years has emerged as the treatment of choice for most renal calculi because it has proved effective, non-invasive and safe. The complications are relatively few though some rare life threatening ones have been encountered. We report here an unusual complication of ESWL wherein 75% of one large stone fragment had pierced through the medial wall of the pelvis and was lying in the extruded state for almost nine months and subsequently was treated with PCNL. To out best knowledge this condition has not been reported previously. Materials and Methods: A 45 old male patient presented to us in September 2006 with complaints f recurrent right loin pain. History was unremarkable and through physical examination was normal. Normal renal excretion with right renal stone and mild hydronephrosis. After 2 sittings of ESWL, he developed steinstrasse and underwent DJ stenting. Subsequently 2 more sittings were given and the stent removed. Almost 60% clearance done but patient kept having ureteric colic due to an additional ureteric fragment. For this he reported back to us. USG and X-ray showed calculus in the right renal pelvis and ureteric calculus and with mild hydronephrosis. Patient was advised RT URS followed by PCNL. URS was uneventful but subsequent RGP showed that the stone was possibly out of the renal pelvis, so PCNL was postponed and patient was sent for CT IVU with ureteric catheter in place for confirmation. This clearly showed that the calculus was only 25% out of medial wall of the renal pelvis. The next day patient was taken up for PCNL and a total clearance was achieved. The extrapelvic fragment were approached via the same rent in the pelvis and removed. Post operative period was uneventful. Discussion: ESWL as a procedure for stone clearance with minimal invasion has been used for over 25 years with very good results. Common complains of patients after the procedure are flank pain and hematuria. Occasion ally one encounters fever and steinstrasse. The rare complications reported are abdominal wall hematomas and abscesses, perinephric hematomas and abscess, and subscapsular hematomas. Few cases of life threatening complications like renal rupture, hepatic and splenic hematoma, intraabdominal bleeding, bowel perforations, arterial pseudoaneurysm, and abdominal aorta dissection have been reported. Our case was unique in that, such a complications involving renal pelvis has not been reported previously to the best of our knowledge. Conclusion: Indiscriminate use of this modality can lead some unforeseen complications like the one we report and care is to be taken in adjusting the voltage and frequency of shock waves. Also, ESWL is to be used only when indicated and should not be used as a substitute for cases where PCNL would be the preferred modality. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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