case_images: PMC10758889_01
case_images: Abdominal X-ray. (a) The arrow indicates the staghorn stone which was 43 mm as long diameter in the renal pelvis and lower calix before PNL. (b) The arrows indicate the dust and multiple residual fragments smaller than 3 mm diameter in the lower calix on the next day after the first PNL. (c) The stone fragments were completely removed after the 2nd PNL.
case_images: IJU5-7-18-g004.jpg
case_images: PMC10758889_01_IJU5-7-18-g004.jpg
case_images: iju512657-fig-0001
case_images: A 56-year-old woman with staghorn calculi with 43 mm as long diameter in the abdominal X-ray (Fig. 1a) was referred to our hospital. The dust and multiple fragments smaller than 3 mm diameter were seen in abdominal X-ray on the next day of PNL (Fig. 1b), and hemoglobin drop was not seen (11.9 g/dl). The 2nd PNL by flexible nephroscope and basket retrieval device was performed on the 19th day (operation time was 51 min), and she could discharge without residual fragments on the 30th day from the first PNL (Fig. 1c).
case_images: (a) Pre-operative non-contrast computed tomography (CT); The long arrow indicates the planned puncture line into the dorsal-middle calix in the anterolateral zone compared with usual, because we should avoid the renal cyst (the short arrow). (b-d) Contrast-enhanced CT after the bleeding. (b) The arrow indicates the nephrostomy tube. There was no active bleeding around the left kidney. (c,d) The arrows indicate the extravasation of contrast agents in the abdominal wall.
case_images: IJU5-7-18-g003.jpg
case_images: PMC10758889_01_IJU5-7-18-g003.jpg
case_images: iju512657-fig-0002
case_images: We planned to puncture into the dorsal-middle calix along the anterior line to avoid the renal cyst (Fig. 2a). 0.035-inch guidewire was successfully inserted into the urinary collecting system at the first puncture of the 18 gauge needle guided by ultrasound and fluoroscopy. The extravasation of contrast agents was seen in the abdominal wall (Fig. 2b-d).
case_images: TAE was performed emergently. (a,b) The arrows indicate active bleeding at the distal branches of the 10th and 9th intercostal arteries which embolized by gelatin sponges. (c) The arrows indicate a communicating branch between the 10th intercostal artery and the left circumflex iliac artery which was also embolized. (d) There was no active bleeding in the renal angiography.
case_images: IJU5-7-18-g001.jpg
case_images: PMC10758889_01_IJU5-7-18-g001.jpg
case_images: iju512657-fig-0003
case_images: The injuries of the distal branches of the 9th and 10th intercostal arteries were identified and embolized by gelatin sponges cut into 1 mm size through the micro-catheter involving the communicating branch of the circumflex iliac artery (Fig. 3). The blood pressure had been recovered to 97/65 mmHg as soon as closing TAE.