Hybrid lithotripsy for a staghorn renal calculus: a novel minimally invasive approach.

Authors

  • Chaiyong Naulyong Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • Thawatchai Taweemonkongsap Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • Ekkarin Chotikawanich Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Keywords:

Hybrid lithotripsy, Staghorn renal calculus

Abstract

Objective: To present a new approach to treat a large renal calculus. Using a combination of extracorporeal shockwave lithotripsy and intracorporeal laser lithotripsy through flexible ureteroscopy.
Case presentation: A 60-year-old female presented with history of 2 occasions of acute left pyelonephritis and treated with intravenous antibiotic. IVP revealed normal nephrograms, incomplete double collecting system with mild dilatation of calyx at lower moiety of left kidney and staghorn stone, measured about 3.59 cm in longest diameter was noted. Therefore a combination of two procedures; shock wave lithotripsy or retrograde intrarenal surgery was set. After urine was sterile, the patient underwent surgery under general anesthesia. Shockwave lithotripsy was set first, followed by retrograde intrarenal surgery. There was no major perioperative complication. The patient came follow up 2 weeks after surgery, there were multiple small fragments in the calyx. However, no auxiliary procedure was required. Last
follow up was 4 months after surgery, there was no residual stone in the lower calyx. Stone analysis revealed pure struvite stone.
Conclusion: Hybrid lithotripsy is a new approach to treat large renal calculus.
Favorable outcomes were achieved with less invasiveness and acceptable stone free.

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References

1. Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: AUA/Endourology Society Guideline; 2016.

2. Srisubat A, Potisat S, Lojanapiwat B, et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2014 Nov 24;(11):CD007044.

3. Desai M, Sun Y, Buchholz N, et al. Treatment selection for urolithiasis: percutaneous nephro-lithomy, ureteroscopy, shock wave lithotripsy, and active monitoring. World J Urol. 2017;35(9): 1395-1399.

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Published

2018-06-30

How to Cite

Naulyong, C., Taweemonkongsap, T., & Chotikawanich, E. (2018). Hybrid lithotripsy for a staghorn renal calculus: a novel minimally invasive approach . Insight Urology, 39(1), 48–53. Retrieved from https://he02.tci-thaijo.org/index.php/TJU/article/view/242708

Issue

Section

Surgical technique

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