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35 year old male
Presents with Severe abdominal pain with intermittent vomiting for 2 weeks
The patient had been experiencing severe abdominal pain and recurrent vomiting for the past two weeks. He sought treatment at multiple medical setups, but received no relief from his symptoms. Persistent discomfort prompted a detailed evaluation at Shiv Hospital.
Ultrasound (USG) Abdomen & Pelvis: Revealed 3 large calculi located at the right PUJ (Pelvi-Ureteric Junction) with associated hydronephrosis and dilated proximal ureter.
CT urography Confirmed the presence of 3 big sizeable ureteric stones causing significant hydroureteronephrosis.
1. Right distal ureteric calculi (multiple and large)
2. Failed conservative/medical management
3. Obstructive uropathy requiring surgical intervention
4. The patient was advised Ureteroscopic Lithotripsy (URSL) with DJ stent placement, given the non-response to medical treatment and evidence of urinary obstruction.
5. Spinal anesthesia was administered uneventfully.
6. Lithotomy position after sterile preparation.
7. A semi-rigid ureteroscope was introduced into the urethra and bladder. The right ureteric orifice was visualized and accessed.
8. Three large calculi were found lodged in the distal right ureter.
9. The stones were fragmented using a Holmium-YAG laser.
10. All fragments were removed with a stone basket without injury to the ureter.
11. A double J (DJ) stent was positioned correctly under fluoroscopic guidance to ensure free urine flow and prevent re-obstruction.
12. Thorough inspection ensured complete clearance of fragments; no bleeding or ureteral injury noted.
13. The patient was transferred to the ICU in stable condition.
14. Effective pain control and hydration maintained.
15. Continuous monitoring ensured no signs of infection or obstruction.
16. Foley catheter placed for urine output monitoring.
The patient had an uneventful recovery and was successfully discharged in stable condition. Follow-up is scheduled for DJ stent removal and further evaluation.
This case highlights the expertise of the Shiv Hospital Urology Team, who successfully treated a complex case of obstructive ureteric calculi through minimally invasive surgery. The patient, who had previously found no relief elsewhere, walked out pain-free and satisfied — a testament to the hospital's commitment to advanced urological care and patient-centered outcomes.
