A giant ureteral stone in a 32-year-old man: a case report

A giant ureteral stone in a young adult: A case report

A large ureteral stone is a rare condition that can cause significant complications if untreated. We report the case of a 21-year-old male from Farah province who experienced abdominal pain for eight months, with localized lower abdominal pain for the last two months, and frequent urination but no hematuria. Imaging revealed a 9 × 4 cm stone lodged in the lower ureter. The patient underwent ureterolithotomy, and a double J stent was placed. Postoperative outcomes were excellent. Stones larger than 10 cm are exceptionally rare, and this case emphasizes the need for prompt diagnosis despite atypical symptoms.

Holmium laser lithotripsy reduces complications and relieves postoperative pain in elderly patients with urinary calculi

OBJECTIVE

To investigate the effectiveness of ureteroscopic holmium laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in elderly patients with ureteral calculi.

METHODS

In this retrospective study, clinical data of 220 elderly patients with urinary calculi hospitalized in Zhumadian Central Hospital from March 2018 to December 2019 were analyzed. Among the 220, 104 patients were treated with PL (PL group) and the other 116 were treated with HLL (HLL group). The two groups of patients were compared regarding surgical conditions, postoperative complications, physiologic stress response, pain level, and restoration of cognitive and renal function.

RESULTS

Compared with the PL group, the HLL group had significantly shorter surgical duration, earlier time to first ambulation, shorter hospital stay, lower intraoperative bleeding, and higher stone-free rate. No significant differences were observed between two groups in complications. The norepinephrine (NE), cortisol (COR) and C-reactive protein (CRP) levels were all reduced postsurgically, but those in the HLL group were lower than those for PL. The VAS and MMSE scores in the HLL group were lower than those in the PL group at 6, 12, 36 and 48 hours after surgery. The blood urea nitrogen (BUN) and serum creatinine (SCr) levels decreased after surgery, and the decrease was greater in the HLL group. The WHOQOL-BREF scores in HLL group were higher than those of the PL group (P<0.05).

CONCLUSION

Ureteroscopic HLL was shownhighly effective in promoting postoperative rehabilitation and reducing postoperative complications, pain, and physiological stress response, as well as crushing stones, with little impact on cognitive function.

Laparoscopic removal of a giant middle ureteral stone: A case report and review of literature

Giant ureteral calculi stones defined as larger than 5 cm in length or circumference. Although many giant ureteral stones have been reported, the laparoscopic removal of these stones is rare. A 45-year-old male patient presented to our clinic with right flank pain and discomfort from 6 months ago. Abdominopelvic computed tomographic scan showed a giant left middle ureteral stone. On the first stage laparoscopic ureter lithotomy was performed with 3 ports and the stone was extracted from 12 mm port successfully. We used transperitoneal laparoscopic approach in the full lateral decubitus position. three trocars were placed: one camera 11-mm port was placed at the level of the umbilicus on the lateral border of the rectus muscle, a 5-mm port was placed in the midline below the umbilicus, and a 12-mm port was at the superior border of the rectus muscle. The extracted stone size was 6.5*1.7 cm with 33 gm in weight. Due to the advantages of laparoscopic ureter lithotomy in giant ureteral stones and its feasibility to perform in a single session, we could suggest this minimally invasive treatment as a first choice in this group of patients.

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Treatment of giant ureteral stone is a subject of controversy in urology.

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Here we report the third largest ureteral stone in the world which was extracted by laparoscopic technique.

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Laparoscopic ureter lithotomy could be suggested for giant ureteral stones as a preferred treatment.