Ureteroscopic Lithotripsy (URS) di RS Harapan Bunda

Summary

The video follows a medical procedure performed on a 63-year-old woman with chronic kidney disease (CKD) undergoing hemodialysis. The patient has significant kidney stones, including a large one in the right proximal ureter. The doctor plans to remove the stones using a specialized procedure and insert Double J stents in both ureters. The procedure involves high-tech tools, and while there are complications with the stone removal, the operation is ultimately completed. The doctor shares insights into the complexity of the case and the medical approach used to address the issue.

Takeaways

• 😀 The patient is a 63-year-old woman with Chronic Kidney Disease (CKD) and is undergoing regular hemodialysis.
• 😀 The patient was referred by an internist for surgical consultation due to a renal stone in the proximal right ureter.
• 😀 The stone in the right ureter is quite large, over 1 cm, and has caused an obstruction.
• 😀 Additionally, there is a Grade 4 stone in the left kidney, with another stone visible on the left side as well.
• 😀 The planned surgical procedure involves placing a Double J stent on both the right and left sides to manage the stones.
• 😀 The surgical team plans to use a specific tool ('Where's live TV') to assist in stone removal, as the right-side stone is high in the ureter.
• 😀 The team also plans to use advanced techniques such as a special catheter for accessing high stones in the ureter.
• 😀 Despite challenges, the procedure is successfully carried out, with the right-side stone being targeted and removed using specialized equipment.
• 😀 A Double J stent is placed on the left side to address the kidney stone, but complications arise due to severe obstruction on the right side.
• 😀 The procedure is completed with positive results, though the difficulty of the right-side obstruction was a notable issue during surgery.

Q & A

What medical condition does the patient have?

The patient has Chronic Kidney Disease (CKD) and is undergoing routine hemodialysis (HD).

What is the primary reason for the patient's referral for surgery?

The patient was referred for surgery due to a large stone in the proximal right ureter and a stone in the left kidney, both requiring surgical intervention.

What is the size of the stone in the right ureter?

The stone in the right ureter is over one centimeter in size.

What type of surgical procedure is planned for the patient?

The planned procedure involves placing Double-J stents in both the right ureter and left kidney to manage the stones.

What is the significance of the 'Double-J' stents?

Double-J stents are used to help keep the ureter open and allow urine to flow around a stone, facilitating its removal or passage.

What complication does the patient face with the right ureter?

The right ureter has a proximal stone that is large and has caused significant obstruction, making surgical intervention necessary.

What approach is used to treat the stone in the right ureter?

A laser technique is used to treat the stone in the right ureter, likely involving lithotripsy to break the stone into smaller pieces for easier removal.

What is the challenge mentioned in the procedure?

The challenge is the significant obstruction in the right ureter, which is quite serious and requires careful management.

Why was the patient’s kidney stone condition considered serious?

The kidney stone condition was considered serious due to the size of the stones and the risk of further complications, including severe obstruction of the ureter.

What is the next step after the procedure?

After the procedure, the patient will be monitored, and the possibility of stone passage will be evaluated, particularly regarding the left kidney stone.