Rare lithotripsy case for patient with kidney 'protruding' into chest.

Doctors from the Urology and Andrology Department of E Hospital have successfully performed a particularly difficult percutaneous endoscopic lithotripsy procedure on a 65-year-old male patient with severe ankylosing spondylitis and serious body deformities.

According to Dr. Nguyen Dinh Lien, Head of the Urology and Andrology Department at E Hospital, the patient was admitted with severe bilateral lower back pain and prolonged fatigue due to kidney stones and ureteral stones causing obstruction.

Examination and imaging results revealed hydronephrosis caused by a long-standing obstruction from a ureteral stone. However, what made the case particularly challenging was the severe spinal deformity that had persisted for many years, coupled with the abnormally positioned kidney, close to the pectoral vault.

Dr. Nguyen Dinh Lien examines a patient - Photo courtesy of the hospital.

According to the patient's medical history, he was involved in a traffic accident nearly 20 years ago. After the accident, his spine gradually became severely deformed, his body increasingly bent over, and he lost the ability to move normally. For 18 years, he lived with almost constant pain, difficulty in daily activities, and a noticeable decline in his physical condition.

About a year ago, the patient was diagnosed with kidney stones. The family took him to several medical facilities, but intervention was met with apprehension due to his advanced age, weak physical condition, complex spinal deformity, and multiple underlying medical conditions.

Initially, doctors planned to perform retrograde endoscopy to access the ureteral stone. However, due to the abnormally angled ureter caused by prolonged kyphosis, the instruments were almost unable to reach the stone's location.

Right in the operating room, Dr. Nguyen Dinh Lien's team quickly consulted and decided to switch to percutaneous endoscopic lithotripsy.

However, the narrow, closely spaced ribs severely restrict access to the renal pelvis. Even a small error during the puncture procedure can lead to pleural damage, bleeding, or procedural failure.

"This is a very rare case because the anatomy is almost completely altered. Every step needs to be calculated with extreme precision to find a safe access route to the renal pelvis," shared Dr. Nguyen Dinh Lien.

After much effort, the team finally created a safe access route to the renal pelvis. In just about 10 minutes of lithotripsy, the rough-surfaced, firmly attached ureteral stone causing the prolonged obstruction was successfully removed, freeing up the urinary tract.

According to doctors, if left untreated, prolonged obstruction can severely impair kidney function, increase the risk of urinary tract infections, and lead to many other dangerous complications.

Thanks to the application of minimally invasive methods, patients experience significantly less post-operative pain, recover faster, and have a reduced risk of impaired kidney function.

Post-operative patient care - Photo courtesy of the hospital.

Doctors advise people not to ignore symptoms such as lower back pain, burning or difficulty urinating, or persistent lower back pain, as these could be signs of urinary tract stones. Early examination helps in timely detection and treatment, avoiding the risk of complications affecting kidney function.

In particular, for individuals with spinal conditions, musculoskeletal deformities, or multiple underlying health issues, regular health check-ups and early treatment are crucial to minimize the need for complex interventions later on.

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Source: https://khoahocdoisong.vn/ca-tan-soi-hiem-gap-cho-benh-nhan-co-than-chui-len-nguc-post2149102010.html