A case of giant renal calculus with poorly functioning opposite kidney

Dev böbrek taşı üroloji pratiğinde nadiren görülmektedir. Karşı taraf böbrek fonksiyonu kötü ve dev böbrek taşı olan 69 yaşındaki bayan hasta sunulmaktadır. Hastanın 10 yıl önce geçirilmiş sağ piyelolitotomi hikayesi vardı. Ultrasonografi (USG), kontrastsız bilgisayarlı tomografi (BT), direkt üriner sistem grafisi (DÜSG) ve intravenöz piyelografi (İVP) ile sağ böbrekte dev böbrek taşı (10 x 8 cm) ve III. derece hidronefroz, sol böbrekte ise orta derecede kaliksiyel dilatasyon saptandı. Dietilen triamin pentaasetik asit ( DTPA ) böbrek sintigrafisi, taşın olduğu böbreğin iyi fonksiyona, karşı taraf böbreğin ise kötü fonksiyona sahip olduğunu gösterdi. Hastaya sağ piyelolitotomi yapıldı. Taşın alımı sırasında taş kendiliğinden 5 parçaya ayrıldı ve bu da işlemi daha da kolaylaştırdı. Taşlar herhangi bir komplikasyon olmadan çıkarıldı ve double-j ( DJ ) stent konuldu. Taş analizi ile taşın kalsiyum fosfat taşı olduğu saptandı. Operasyon sonrası 2. ayda çekilen DÜSG ve İVP, taşın tamamen temizlendiğini ve sağ böbrek pelvisinde orta derece dilatasyon olduğunu gösterdi. Bu olguda olduğu gibi, günümüzde, açık taş cerrahisi bazı özel olgular için hala kabul gören alternatif bir tedavi yaklaşımıdır.

Karşı taraf böbrek fonksiyonu kötü olan bir dev böbrek taşı olgusu

Giant renal calculus is rarely seen in urologic practice. A 69-year-old woman who had right giant renal calculus with poorly functioning opposite kidney is presented. She was with a history of right pyelolithotomy for large renal calculus 10 years back. Ultrasonography(USG), uncontrast computed tomography ( CT ), plain abdominal X-ray ( KUB ) and intraveneous urography ( IVU ) revealed a giant renal calculus (10 x 8 cm) and grade III hydronephrosis on the right kidney and moderate calixiel dilation on the left kidney. Diethylene triamine pentaacetic acid ( DTPA ) renal scan showed good functioning affected kidney and poor functioning opposite kidney. Right pyelolithotomy was performed. During the manuplation of the stone removal, the stone was divided into five pieces spontaneously. This situation made the procedure easier. The stones were extracted without any complications, and a double-j ( DJ ) stent was placed to the patient. Chemical analysis of the stone revealed a calcium phosphate stone. KUB and IVU showed complete stone clearence and modarate dilatation on the right renal pelvis on the second month postoperatively. Like this case, today, open stone surgery is still continues to represent a reasonable alternative treatment option for some special cases.

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