Treatment options include nephrectomy when there is no salvageable kidney function or pyeloplasty and pyelotomy
when some kidney function can be preserved.
Informed consent was obtained for percutaneous antegrade nephroscopic stent retrieval and replacement, including laser pyelotomy if necessary.
The posterior location was away from the renal vessels, thus allowing a safe percutaneous approach, including laser pyelotomy. Due to the close proximity of the main renal vessels and segmental branches, we do not recommend laser pyelotomy for any anteriorly-oriented extruded stents unless a preoperative CT scan clearly shows the site of extrusion to be well away from the vessels.
A decision was made to explore the case, through a flank retroperitoneal incision, pull the catheter out and extract the renal pelvic stone through a pyelotomy. Before we did the exploration, we consulted with cardiology.
We did open surgery for this case, mainly to remove the renal pelvic stone using pyelotomy, and to be ready for any possible adverse event.
Postoperative fever is a common medical complication associated with PNL (23%-25%),[sup.27] and urosepsis develops in only a small fraction of these febrile patients (1%-2%).[sup.28] LPL complications usually relate to the pyelotomy
closure and the stone removal.