A 50-year-old man with a history of lumbar spine fixation due to disc herniation presented with poorly radiopaque coralline lithiasis in the right renal pelvis, with foot dilatation and delayed elimination in the UIV.
An alkalinizing treatment with potassium citrate (Acalkamé) is administered at a dose of one tablet every 8 hours for 3 months and the placement of a right double J catheter.
Subsequently, three sessions of extracorporeal shock wave lithotripsy are programmed and an IVU is requested after treatment aiming at functional cancellation of the renal unit, despite the placement of a double J catheter.
1.
To assess the functional status of the right kidney an isotopic renogram and renal scintigraphy with low isotopic uptake of the right kidney and flat and obstructive curve after administration of the diuretic in the renogram is performed.
Total renal function of the right kidney is 9%.
Right ileoscopies were performed under anesthesia to try to determine the origin of the renal annulus. During the procedure, a long-term (8-10 cm) ureteral and iliac strictures were observed.
A standard guide (Cordis, 150 long and 0.90 mm wide with a lining of polytetrafluoroethylene) was adhered to and the kidney was repeatedly dissected with the ascending pelvis atmosphere to avoid the ureteral obstruction.
Once the ureteral dilation attempts were completed, it was decided to place a double J stent that could be easily assisted by the working guide.
However, when attempting to remove this guide, it is observed that the intrapyellic loop has formed a knot that prevents its removal.
1.
At this time, the patient has two therapeutic options: percutaneous approach for loop extraction or nephrectomy, given the poor functionality of the right kidney and long ureteral stenosis and difficult resolution with conservative measures.
The patient adopted by the second option performing right nephrectomy if significant operative incidences, and the patient was asymptomatic in successive visits to the external consultation.
