Flexible ureteroscopy for a blocked intrarenal double JJ stent in a patient with a renal staghorn ca скачать в хорошем качестве

Flexible ureteroscopy for a blocked intrarenal double JJ stent in a patient with a renal staghorn ca

A 60 years old patient diagnosed with left kidney stones following a renal colic episode managed initially with the insertion of a double JJ ureteral stent. Imaging highlights the presence of a left staghorn calculi about 43/17/34mm with a hardness of 900-1200 HU. After presenting the surgical options to the patient a staged flexible ureteroscopy with laser lithotripsy was decided. Fluoroscopy noticed a particular position of the double JJ stent that was not possible to be removed, which is why we practice an ureteroscopic approach (semi-rigid / flexible) with the laser section of the stent and partial stent extraction due to the reduced caliber of the proximal ureter. A second double JJ stent was inserted at this time. Three weeks down the line a flexible ureteroscopy was performed via a 12/14Fr ureteral access sheath with the complete extraction of the blocked stent and incomplete Holmium Laser lithotripsy. The second session of flexible ureteroscopy was performed 3 weeks after the first one that allowed a complete Holmium Laser lithotripsy and fully extraction of the stone fragments.