Large Lower Uretric Calculus cleared with Holmium Laser

This is the plain CT image of a 55 y gentleman who presented with left flank pain, revealing a large 2.7x1.6 cm left lower ureteric calculus. It was completely fragmented by holmium laser endoscopically. He was discharged on the next day in a stable condition.

Post Op KUB

UTERINE PROLAPSE CAUSING OBSTRUCTIVE UROPATHY AND RENAL DYSFUNCTION

UTERINE PROLAPSE

A 55 Y lady presented with features of chronic renal failure. On detailed history she also complained of recurrent uterine prolapse for the past 15 years. On evaluation she had bilateral severe hydroureteronephrosis and renal parenchymal atrophy. Her serum creatinine was - 2.5 mg%.
Cystoscopy showed severe urethral kinking and a grossly trabeculated bladder. RGP revealed B/l severely dilated and tortuous ureters. B/l Double J stents were kept with extreme difficulty, and a vaginal hysterectomy was done. post operative period was uneventful.

Plain CT S/O B/L Gross Hydroureteronephrosis

Plain CT S/O B/L Gross Hydroureteronephrosis

TITBITS IN URORADIOLOGY

1. Pancreatic calcification MASQERADING as kidney stone. 

This is as plain X-ray KUB of 44 years gentleman presenting with right flank pain. On evaluation there was a right upper ureteric calculus with Hydroureteronephrosis  and a left lower calyceal calculus . Right URS Laser Litho + JJ stenting was done . This is post operative KUB showing radio-opaque density in the right renal fossa. He is known case of chronic calcific pancreatitis.   

Pancreatic calculus

TITBITS IN URORADIOLOGY

1. PANCREATIC CALCIFICATION MASQUERADING AS KIDNEY STONE

Nephrectomy for pyonephrotic kidney

A 60 year old lady came with on and off fever and left  iliac fossa pain.On evaluation she was found to have ectopic enlarged kidney with pyonephrosis.She was a known case of atrial septal defect with early changes of Pulmonary Arterial Hypertension.She was taken up for open nephrectomy with Extended Gibsons incision.Subcapsular nephrectomy was performed for the planes around the kidney were obscured because of adhesions.The patient recovered well after the surgery and was discharged on 4 th post operative day.

The specimen of the kidney is shown below..

Real time imaging of ESWL

This is a real time image of ESWL showing fragmentation of a kidney stone into fine powder.

This procedure is being performed on the state of the art Dornier Compact Delta ESWL machine. The ESWL if scrupulously done can avoid PCNL and subsequent RIRS in significant number of cases.

The most important thing for ESWL success is choosing right case (Naveen et al. WCE 2004 .Predicting factors for ESWL), continuous real time image monitoring by trained professional, under anaesthesia cover (compromised intensity for pain can have compromised outcome too...).

Large Staghorn kidney stone in a patient with myelodysplastic syndrome removed by PCNL through a SINGLE TRACK

            A 60 year gentleman, suffering from myelodysplatic syndrome presented with left flank pain. On evaluation there was a complete staghorn calculus in the left kidney. He had a history of left open pyelolithotomy 20 years ago. His coagulation profile was normal. PCNL was done through superior calyceal puncture, and complete stone clearance was achieved. Postoperative recovery was uneventful.

Pre Operative KUB

Post Operative KUB

Partial staghorn kidney stone removed by PCNL through a single track

              A 50 year gentleman presented with left flank pain.On evaluation there was a partial staghorn calculus in the left kidney. Percutaneous nephrolithotomy (PCNL) was done through posterior inferior calyceal puncture. One middle calyceal stone fragment was removed by harpooning with the puncture needle. Complete clearance was achieved. Postoperative period was uneventful.

Plain KUB

IVP

Post Operative KUB

UNUSUAL CASE OF BLADDER CANCER WITH STAGHORN KIDNEY STONE

A 65 year old female patient presented with burning micturation, pain in right flank, fever since 3 months followed by not passing urine(Anuria) since 1 week.

She was diagnosed to have Kidney failure with serum creatinine 3.5 dated 12/12/2011 On 13/12/2011-Serum Creatinine was 4.9 Ultrasound :reveals Right severe hydronephrosis with renal staghorn calculus 42mm,Left hydroureteronephrosis, changes of Cystitis.

CT scan of abdomen : shows Right renal staghorn calculus with satellite calculi and gross hydronephrosis with thinning of the cortex.

Left moderate hydroureteronephrosis – compensatory functioning. Grossly thickened urinary bladder wall. 

Cystoscopy-Severe Trigonitis, bladder thick walled, illdefined mass at bladder outlet, ureteric orifices not identified. EUM-narrow dilated with Hegar dilators. Mucosal biopsy taken

 As Ureteric orifices were not seen so fluroguided Bilateral PCN was done. Serum creatinine was repeated after Cystoscopy 2.3. Right PCNL was done with Single Track and stone was completely cleared, and then Serum creatinine was 1.0

In view of infiltrative bladder growth and bilateral hydroureteronephrosis, Radical cystectomy + Ileal conduit was done.

Final HPE Report - Infiltrative Squamous cell carcinoma stage pT4 N0 M0

Post Operative Recovery uneventful

Pre Op KUB

Post Op