ESWL For Kidney Stone Larger Than 20 mm
A 50 years old female patient was evaluated for Right Flank Pain. She was a recurrent stone former with history of Surgery (PCNL and endoscopic surgery) on two separate occasions in the past. On evaluation she was found to have Rt Large Renal Pelvic Calculus measuring 24X20 mm and two small lower pole calculi measuring about 6-8 mm. A Surgical procedure called PCNL was advised at all the hospitals as it was the preferred Procedure.
The Patient was reluctant for the third surgery and consulted us for the possibility of ESWL. On further evaluation it was found that the stone was soft in consistency, ESWL was still a possible option. She was informed about the procedure details along with its limitations and after making the patient understand about the success rates & limitations of ESWL, she underwent DJ stenting followed by ESWL at our center .
The very next day she started passing sand like fragments and the entire stone bulk was cleared in just two sittings. She underwent DJ stent removal after the stone clearance.
ESWL in Morbidly Obese Patient
Recurrent Urolithiasis is a major problem. Patients have to often undergoes multiple surgeries. We had an opportunity to treat a patient with recurrent urolithiasis who has undergone three surgeries in the past 10 years. She was evaluated for hematuria and was diagnosed with a 22X10 mm right renal pelvis calculus with a small Rt ureteric calculus. She was totally disheartened when she got to know that she required another surgery.
When she consulted us, her first words were " doctor do something, I don't want to undergo another surgery"
She was morbidly obese weighing 130 kgs with DM, HTN and Hypothyroidism. The stone was not visible on X ray. CT HU was 400- 500. On ultrasound examination, we could see the stone clearly through a small flank window. we gave her an option of EWSL with DJ stenting ( Since she was diabetic which was not well controlled).
She underwent Ultrasound guided ESWL. She passed multiple fragments and cleared the entire stone burden. She required three sittings with a week gap. the stent was removed after confirming the clearance on NCCT KUB.
The smile and happiness which she had after the successful procedure made me feel I am #ProudToESWL