Category: Other, Miscellaneous

VS15-14 - One step surgery: Renal plus uretheral lithiasis and renal urothelial tumor

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

We present a case of one step surgery: renal plus ureteral lithiasis and renal urothelial tumor (supine PCNL and URS).  
An 80-year-old male suffering from diabetes mellitus non-insulin dependent. Came to our clinic due to a bladder tumor in the right meatus. After TUR we performed a CT showing right hydronephrosis IV/IV caused by a two lithiasis in the lower ureter, 8 mm and 13 mm each one. There was another lithiasis of 23 mm and 1096 HU, in the lower right calyx. Also, it could be seen a thickening in the right renal pelvis.

Methods :

Galdakao position was used to perform the surgery. This position can help us to do a combined surgery. First, we tried to pass a sensor guide through the right meatus. As it was sealed by the previous TUR, we had to perform a percutaneous access. To perform the access a percutaneous access needle with echogenic tip was used, it was guided sonographically and radiologically through the lower calyx. First, we performed a progressive dilatation with fascial dilators and then we used a balloon, prior passage of safety guide through a double light catheter. A 30 F Amplatz type renal sheath was used.
We are used to apply ballistic energy in the PCNL surgery, to get a faster and better stone fragmentation. To remove stones in this case we used a nitinol tipless stone extractor.
A standard straight tip guidewire passed along the ureter, and then sensor guide through a double light catheter which achieved the bladder, and it was taken out with cystoscopy.
To remove the tumour, we performed a resection using percutaneous access, and then coagulation. We took two samples and the base separately. The pathological anatomy shown a low-grade tumor, the base was artifacted. Subsequently, we took the flexible cystoscope to review. 
Ureteral lithiasis were treated by ureterorenoscopy with holmium laser.
To conclude the procedure, we placed a nephrostomy for 24 hours and a ureteral stent for 2 weeks. The postoperative time was 2 days, and no complications were observed

Results : No residual fragments appeared in the X-ray, and the pathological anatomy shown a low-grade tumor.

Conclusions :

This surgery can show that it is possible to treat lithiasis and urothelial tumor in one step surgery, using Galdakao position, when the retrograde access is impossible.

Javier Perez-Ardavin

Resident fith year
Hospital Universitari i Politècnic La Fe
Valencia, Comunidad Valenciana, Spain

I´m Javier Pérez Ardavín, resident of fith year, Urologist, in the Hospital la Fe in Valencia.

Marta Trassierra

Hospital Universitari i Politècnic La Fe
Valencia, Comunidad Valenciana, Spain

Jose VICENTE. Sanchez-Gonzalez

Valencia, Not Applicable, Spain

I am final year resident in urology in Valencia, Spain

Domingo de Ordaz Jurado

Jose Daniel López-Acón

Hospital Universitari i Politècnic La Fe
Valencia, Comunidad Valenciana, Spain

Pilar Bahilo Mateu

Alberto Budia Alba

Francisco Boronat Tormo