with Dr. Cecilia M. Cracco, Dr. Cesare M. Scoffone
Retrograde and antegrade combined access to the collecting system, with both rigid and flexible scopes. Procedure steps: · Cystoscopy for left JJ removal · Semirigid ureteroscopy · Digital flexible ureteroscopy · US-oriented, fluoroscopy-guided and Endovision-controlled percutaneous puncture · Tract dilation (fascial dilators and balloon), Amplatz sheath insertion 24 Ch · Combined (pneumatic and ultrasound lithotripsy), with litholapaxy with N-Perc and irrigation · Combined final exploration of all calyces · Final JJ stenting and 8Ch pyelostomy closed, catheter Learning Points · The combined use of rigid and flexible scopes · The combined use of the retrograde and antegrade approaches · The diagnostic (and active) role of retrograde flexible ureteroscopy How to improve efficacy and safety of the percutaneous procedure
Clinical Background
54-year-old female patient
ASA II, no allergies, no smoke
91.0 kg, 160cm, BMI 35.5
Left 2 cm pyelic stone with double JJ stent and 36% function
Technique Description
02/2018 recurrent left lumbar pain
Access to the Emergency Department
US = left kidney stone
NCCT = left 2 cm pyelic stone with hydronephrosis
Left JJ inserted
Renal scintigraphy = right 64%, left 36%
One caesarean delivery
Tonsillectomy
Hysteroannessiectomy
Thyroidectomy for cancer followed by radioactive iodine therapy
Two herniated lumbar discs
Autoimmune arthritis
Chronic kidney failure (creatinine 1.75 mg/dl)
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