Pyonephrosis, stones and intervention

Case contributed by Dr Ian Bickle

Presentation

Renal stone disease, with recent right ureteric calculus and pyonephrosis

Patient Data

Age: 45 years
Gender: Male

Right kidney showing a moderate-severe hydronephrosis. 

Left kidney with staghorn calculus with intense posterior acoustic shadowing.

 

Left sided staghorn calculus. Right sided multiple small renal stones and a stone in the proximal urter, causing mild upstream obstructive changes. 

Lower pole puncture - thick frank pus within the collecting system

Severe right hydrophrosis on prior ultrasound.

Case Discussion

Patient with known nephrolithiasis.  Presented with right sided renal colic and fever.

Initial plain film shows bilateral renal calculi.  CT-KUB bilateral renal stone disease and hydronephrosis.  On ultrasound the right sided hydronephrosis is illustrated and left staghorn calculus. 

Percutaneous nephrostomy performed, which identified a pyonephrosis.

Subsequent to this ureteroscopy and stone removal performed and placement of a retrograde ureteric stent.

The final plain abdominal radiograph shows a feft staghorn calculus, right sided percutaneous nephrostomy and ureteric stent.

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