"CALCULI OBSTRUCTIVE UROPATHY, A UROLOGICAL CHALLENGE"

Introduction

The cases of Obstructive Uropathy vary from childhood to adulthood to geriatric age group, but calculus disease remains one of the commonest causes in all.

One centre being a kidney stone centre caters to various stone diseases. Selection of the modality of treatment depends upon the severity, size and degree of obstruction. But Percutaneous nephrostomy remains the first line of treatment in almost all cases.  

Material and Methods

We have encountered 9 cases of calculus obstructive Uropathy in nearly 2 years. Non-calculus diseases are not included in this study. 3 patients (33%) out of 9presented with B/L ureteric stones, 2 cases (22%) had B/L renal calculus with echogenic, hydronepurotic kidneys, 2 cases (22%) had solitary kidney with lower ureteric stone. U.S.G. guided P.C.N. (per cut nephrostomy) remained the 1^st modality of treatment. Push and D.J. stenting was done in upper ureteric stone, later treated by ESWL clearance. PCNL was done for removal of renal and upper ureteric stone with (previous) same PCN tract in obstructed system. U.R.S. and removal was done in lower ureteric stone.

Result

Kidney reverted to normal function in 80% cases, reverted to near normal in rest 20% cases. Haemodialysis was only required in one case with severe Acidosis before PCN.

Discussion

Percutaneous Nephrostomy is the least invasive, life saving procedure which provides a mature tract for PCNL.  Open surgery is obviated in all so that hospital stay and post operative morbidity is less. Patients resume work faster.

Dr. Ravindra Kumar Sah

Sah Urological & Kidney Stone Centre

Sah Nursing Home, Bulanala, Varanasi (U.P.) 221001