2012, Number 1
Rev Mex Urol 2012; 72 (1)
Laparoscopic management of calcified double-J catheter in thrombocytopenic purpura patient
Urdiales-Ortiz A, Pérez-Becerra R, Santana-Rios Z, Fulda-Graue S, Fernández-Noyola G, Sánchez-Turati JG, Cantellano-Orozco M, Morales-Montor JG, Pacheco GC
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Language: Spanish
References: 9
Page: 39-44
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ABSTRACT
Introduction: Encrustation or calcification of double-J catheters is well-documented. The cause of calcification is multifactorial, and among the known risk factors is that of prolonged catheter indwelling. Catheters should be changed within periods no greater than four months. It is not always possible to identify calcified catheters preoperatively. However, treatment should be rapid and if there is any doubt as to kidney function, renogram should be carried out. If encrustation is minimal, its removal can be attempted under general anesthesia and fluoroscopy, followed by control ureteroscopy.Clinical case: Patient is a forty-five-year-old woman with past history of thrombocytopenic purpura of eight-year progression, treated with prednisone. Patient sought medical attention at the authors’ hospital with history of stone in the right renal pelvis and two calcified double-J catheters in right collecting system. Upon admittance patient did not present with hematuria or pain and platelet count was 25 000. Plain abdominal computed tomography scan showed 1.5 cm stone in right renal pelvis and two calcified double-J catheters. Endoscopic approach was used to resolve distal loops and laparoscopic right pyelotomy was performed to extract double-J catheters en bloc. Renal pelvic stone was then extracted with the aid of flexible nephroscope and Dormia basket. Postoperative progression was satisfactory and patient is currently asymptomatic with no recurrence of lithiasis.
Discussion: Calcified double-J catheter management is one of the most problematic and difficult challenges for the urologist. Its resolution requires the combination of multiple methods such as extracorporeal shock wave lithotripsy, in situ ureterolithotripsy, and percutaneous procedures such as open surgery. Laparoscopic approach is not yet widely used, but it is an excellent minimally invasive option for resolving complex cases in a single procedure and allows for simultaneous endoscopic approach in order to resolve distal loop calcification.
Conclusions: It is extremely important for the attending urologist to communicate to the patient the calcification risks inherent in prolonged catheter use. Follow-up of patients with long-term catheter is essential for avoiding complications. Laparoscopic approach is an excellent option for management of these cases.
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