AINU, Secunderabad Urologists remove 154 stones from right kidney in a 45-year-old man

HYDERABAD: Urologists at Asian Institute of Nephrology & Urology (AINU), Secunderabad, have successfully removed 154 stones from right kidney of a 45-year-old male patient, resident of Ramagundam area in Telangana.

He presented with CT scan report – few calculi in the kidney, the largest calculi measuring approximately 62mm x 39mm.

This large calculi is extending into all calyces of the kidney. He was diagnosed with uncontrolled blood sugars on evaluation.

After obtaining his blood sugar levels under control, he underwent endoscopic surgery – Per Cutaneous Nephrolithotomy.

The large stone measuring 62 mm x 39 mm was fragmented and retrieved in multiple pieces.

All the secondary stones were retrieved intact. The number of stones removed including the largest stone were 154 in total.

Speaking about the patient, Dr. Raghavendra Kulkarni, Consultant Urologist, AINU, said, “Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity, which can be in the form of recurrent urinary tract infections, kidney injury and neglected / untreated cases can end up with need for dialysis. Managing patients with staghorn calculi can be challenging, especially in diabetes mellitus patients. Advances in technology and techniques have enabled effective treatment with minimal morbidity.

“The patient underwent multi-tract PCNL to achieve complete stone clearance. The largest stone measuring about 62mm x 39mm was fragmented and retrieved in multiple pieces. All the secondary stones from all the calyces were retrieved intact.

Secondary stones numbered approximately 153 and the size of the stones varied from as small as 2-3 mm to approximately 10mm. The blood loss was very minimal with no transfusions, and the patient recovered well from Anaesthesia,” Dr Raghavendra Kulkarni added.

PCNL has evolved as the first choice of treatment for patients with complex or large renal stone burdens. Numerous studies have certified the safety and efficacy of PCNL for renal stones. The presence of diabetes mellitus increases the incidence of post-operative complications, especially infectious complications. Dr. Raghavendra Kulkarni is thankful to his team of experts that included Dr. Gopal Ramdas Tak, Dr. Suraj Pinni and anaesthetist Dr. Srinivas. Dr. Raghavendra Kulkarni added, patient with diabetes mellitus and staghorn calculi pose a very tough challenge, he said, team work was very essential in achieving an acceptable / convincing outcome.