Right renal lower calyceal stones-24 years female

24 years female with complains of right flank pain on and off since couple of months.

Occasional hematuria.
Attaching single plate IVU.
Is she need further imagining study?
How will you treat these stones?

Right renal lower calyceal stones-24 years femaleRight renal lower calyceal stones-24 years female


  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    22 May 2020 03:36:48 PM

    Sir...it looks like around 1.5 cm lower pole calculus..with another small stone...

    My approach...
    I would like to do 
                   Urine routine |why? Wants urinary                                       tract to be sterile                   Urine cs
                   Blood count s to rule out infection or platelet numbers and as routine
                   Renal function test, special ly creatine if I plan contrast study and as routine
                  Usg kub general survey or plan an angle of puncture if I plan to do usg guided puncture
                  With it I would like to do a plain CT with ct urogram... relevant anatomy in relation to stone... density...hu relevant if I plan  eswl...infundibulopelvic angle,wide of infundibulam,lenth of infundibulam...thse r necessary if I plan to do rirs...or pcnl

    My plan...
       1) since she is young woman,I would offer her RIRS as my first modality of treatment.sfr  better then eswl, but natural orifice surgery...
      2) ESWL...it will be second...I will inform about pros n cons....least invasive...least sfr...has to pass stone through body I. Real time...chance of infection...pain...
    3)Mini pcnl...best sfr but high morbidity

  • Gyanendra Sharma
    Gyanendra Sharma
    22 May 2020 09:33:51 PM

    My first thoughts on seeing the Single plate IVU

    Why does she have hydronephrosis -- calyceal dilatation seen seen  in all calyces--despite having a lower pole calculus

  • Nitesh Jain
    Nitesh Jain
    22 May 2020 10:05:46 PM

    Is theee a right Ureteric Stone ... remarked in X-ray  ...

    Will do Right RIRS/ ECIRS 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    24 May 2020 09:22:12 AM

    Yes Nitesh,  I agree. 

    May be that is a cause of right HN. 
    This patient presented with single plate IVU done recently. 
    That is why I asked will you ask for anything more on imagining side? 
    Or your decision is RIRS,  in that case it will not make any difference... 

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