International Journal of Advances In Case Reports

IATROGENIC RENAL TRAUMA FOLLOWING URS: A LESSON LEARNT

Kadyan Bhupender*, Mulay Abhirudra, Sabale Vilas, Satav Vikram, Mane Deepak, Kankalia Sharadkumar

drkadyan@yahoo.com

Ureteric stones, Iatrogenic Renal Trauma.

The surgical management of ureteric stones has changed over the past few decades because of advances in instruments and techniques. During the past 20 years, ureterorenoscopy (URS) has dramatically changed the management of ureteral calculi. We report a case of iatrogenic renal trauma following URS. A 53 years male with CKD presented with Right ureteric colic. USG revealed 12mm upper ureteric calculus with hydronephrosis/more in upper calyx. URS done using pneumatic lithotripter. Patient had gross hematuria in recovery. USG revealed significant perirenal collection around upper pole. Inview of unstable condition, patient explored, large perirenal hematoma and appox 3cm ragged tear in dilated upper pole seen. Parenchyma sutured & gelfoam placed to achieve adequate hemostasis. Currently, URS is the main stay in ureteric stone management. Normal renal pelvic pressure varies between 5-15 mmHg. The pressure can rise to approximately 410 mmHg during URS. This pressure is affected by the type of surgical instrumentation used, the height of the medical irrigation pouch, use of manual injection syringe or mechanical cylindrical pumping device, or the fullness level of the bladder during the operation. Commonly encountered complications included fever and/or sepsis, transient hematuria, stone migration, ureteral mucosal injury, ureteral perforation, and ureteral avulsion. Renal rupture is extremely uncommon but still a possible complication, which should be kept in mind in persistent gross hematuria. Ureteroscopy is an invasive procedure. One should be extremely watchful during procedure to avoid complications. High & persistent irrigation pressure should be avoided with intermittent drainage.