Ho Chi Minh City – Mr. Thoa, 60 years old, had a fever, lower back pain, and hematuria. Doctors discovered multiple coral-shaped kidney stones, the largest measuring approximately 3.5 x 2.5 cm, in the right renal pelvis.
Urine culture tests conducted on the patient at Tam Anh General Hospital in Hanoi also detected E. coli bacteria.
On November 27th, Associate Professor, Doctor Tran Van Hinh, Head of the Urology - Andrology and Nephrology Department, stated that the patient's staghorn kidney stones had a complication of urinary tract infection. Approximately 50-70% of kidney stone patients experience this complication, largely due to intestinal bacteria.
After treating the urinary tract infection with antibiotics, the doctor performed percutaneous nephrolithotomy (PCNL) through a small tunnel. Associate Professor Hinh said that staghorn calculi, like Mr. Thoa's, are a complex type of kidney stone. Besides the large stones, the smaller stones are located within the renal calyces, so the time spent locating and breaking them up can be prolonged, leading to complications such as bleeding and retained stones if the surgeon lacks experience.
Dr. Hinh and his team established a tunnel through the skin in the lumbar region, inserting a needle under ultrasound guidance to dilate the tunnel to a circumference of 1.8 cm in order to insert the endoscope into the renal pelvis and each calyx of the right kidney. The stones were fragmented using a high-powered laser and then suctioned out.
Associate Professor Hinh (center) with surgeons performing lithotripsy on a patient. Photo: Tam Anh Hospital.
The surgery lasted 45 minutes, and the patient was fitted with a renal drain and a JJ urinary catheter. After 4 days, Mr. Thoa was discharged from the hospital and returned for a follow-up appointment one month later to have the catheter removed.
Associate Professor Hinh stated that previously, staghorn kidney stones were usually treated with open surgery, but this method prolonged recovery time and easily caused damage to the kidneys and surrounding organs. If the stones recurred, subsequent open surgeries would be difficult, increasing the risk of bleeding and life-threatening complications. By the mid-to-late 20th century, this type of stone was broken up through a standard small tunnel in the skin. The access route to the kidney for this method was very large (2.8 cm in circumference), causing significant damage to the renal parenchyma and easily leading to complications.
Currently, there are many minimally invasive methods for treating kidney stones, depending on the location, nature, and size of the stones, as well as the patient's health and underlying conditions. Preferred methods include percutaneous nephrolithotomy (PCNL), retrograde ureteroscopic surgery, and flexible endoscopy for kidney stone removal.
According to Associate Professor Hinh, minimally invasive endoscopic lithotripsy is a modern technique with many advantages, such as a small incision in the kidney, thus reducing the risk of damage to the renal parenchyma and minimizing the risk of complications, including bleeding during and after surgery. The ultrasound-guided endoscopic procedure helps doctors and patients avoid radiation exposure from X-rays, allows for easy examination of the lithotripsy instrument's position, kidney morphology, and stone location, and detects moving fragments to minimize residual stones. Doctors can detect and treat complications such as perirenal fluid accumulation and ascites early and promptly.
The stones are broken into fragments and suctioned out using a pressure pump under ultrasound guidance. Photo: Tam Anh Hospital
Vietnam is located within the global kidney stone belt due to several risk factors. Endogenous risk factors include chronic gastrointestinal diseases, metabolic disorders such as hyperthyroidism and gout leading to elevated blood uric acid levels, and persistent, recurrent urinary tract infections. Exogenous risk factors include the tropical climate, insufficient water intake, and prolonged exposure to sunlight.
Associate Professor Hinh advises everyone to have regular health checkups to detect diseases early and avoid complications. People with symptoms such as lower back pain, blood in urine, fever and chills, vomiting, burning sensation when urinating, etc., should see a doctor as soon as possible.
Emerald
At 8 PM on November 28th, the online consultation "Dissolving Kidney Stones" will be broadcast on the VnExpress fanpage. The program will feature Assoc. Prof. Dr. Vu Le Chuyen, Director of the Urology - Nephrology - Andrology Center, Tam Anh General Hospital, Ho Chi Minh City; and Assoc. Prof. Dr. Tran Van Hinh, Head of the Urology - Andrology and Nephrology Department, Tam Anh General Hospital, Hanoi. |
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