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Abstract: The patient was found to have a right ureteral stone and a left kidney stone after examination at a local hospital due to right-sided lumbar pain. After treatment of the right ureteral stone at the local hospital, he was hospitalized at our hospital for percutaneous nephrolithotomy to treat the left kidney stone.
Basic Information】Male, 38 years old
Disease Type】Left kidney stone
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of consultation】March, 2020
Treatment plan】Surgical treatment (percutaneous nephrolithotomy)
Treatment Period】7 days of inpatient treatment, long-term follow-up in outpatient clinic
Treatment effect】No recurrence of stones after surgery
I. Initial consultation
The patient came to our outpatient clinic for examination of left kidney stone. 1 month ago, he was examined at local hospital for right ureteral stone and left kidney stone due to right side lumbar pain, and the right ureteral stone was treated by right ureteroscopy at local hospital, and now the patient came to our clinic for treatment of left kidney stone. The receiving doctor checked the local hospital and found that the left kidney stone was about 2.5cm, and was admitted to the hospital with a proposed left kidney stone.
II. Treatment process
After admission, abdominal CT and abdominal plain film were arranged. Both abdominal CT and abdominal plain film suggested left kidney stone, the size was about 2.5cm×2.0cm×2.0cm, and the patient was informed that the most suitable treatment was percutaneous nephrolithotomy. The patient was placed in the prone position after general anesthesia, and an 18 Fr percutaneous renal channel was established under ultrasound guidance, and the left renal stone was crushed and removed using holmium laser. After the operation, the patient was left with one nephrostomy tube, one endoureteral stent tube and one urinary catheter.
III. Treatment results
The patient’s surgery was successful, and all the left kidney stones were removed. Postoperative stone analysis showed calcium oxalate monohydrate stones. The patient was advised to stay in bed for 1 day, and started to get out of bed on the 2nd day after surgery. The catheter was removed on postoperative day 3 and the nephrostomy tube was removed on postoperative day 6, and the patient was discharged. The ureteral stent tube was removed from the patient’s outpatient cystoscopy in January after the operation, and the patient is currently under continuous outpatient follow-up.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still remind the patient that he needs to pay attention to dietary regulation and regular follow-up after surgery. We recommend that the diet should be limited to foods rich in oxalic acid, such as spinach, oleander, cabbage, etc., and that the daily water intake should be 2-2.5 L. After surgery, we recommend that the kidney ultrasound should be checked once a year, and if necessary, the abdominal CT should be checked further.
V. Personal insight
Urinary stones are the most common diseases of the urinary tract, especially upper urinary tract stones are particularly common. It is clear from the treatment of the patient in this case that some basic principles should be followed in the choice of treatment for bilateral upper urinary tract stones, including ureteral stones on one side and renal stones on the other side, priority should be given to ureteral stones, and priority should be given to the side with severe obstruction, while for bilateral renal stones, priority should be given to the side with simple obstruction. All in all, patients are reminded that when the above symptoms occur, they should actively go to the hospital to seek medical solutions.