Prime Hospital successfully performs delicate stenting procedure on 72-yr-old male patient

Prime Hospital successfully performs delicate stenting procedure on 72-yr-old male patient

Problem 

A 72-year-old male patient was referred to Prime Hospital on the night of January 28, 2016 by Lifeline Hospital. He was suffering from anuria, or non-passage of urine, associated with pulmonary edema and acute renal shutdown over the last two days. The patient was intubated upon arrival at the emergency room, with test results showing the following:     

  • Serum creatinine =26 mg/dl-NV up to 1.4 mg/dl
  • Blood urea =304 mg/dl- NV up to 45 mg/dl
  • Serum potassium = 5.8 mg/dl- NV 3.5-5.3 mg/dl

The patient was transferred to the intensive care unit where a dialysis was performed at around 11 on the same night. The next day, January 29, 2016, the patient was still anuric, prompting urologist Dr. Ismail Alkhalidi to order an ultrasound which was conducted at 10 am. The findings indicated bilateral obstructed kidneys (bilateral hydroureteronephrosis). Dr. Alkhalidi then ordered a CT scan which was performed at 11 am. The results revealed bilateral big ureteral calculi in the right ureter (1.5 centimeters) and left ureter (2 cm), both of which were causing the obstructions.

Solution

To remove the obstructions, Dr. Al Khalidi recommended the insertion of Double-J stents in both ureters through endoscopy. Such a move ensures drainage of urine from the kidney into the bladder. The surgery was of high risk given the patient’s poor health condition. The family was informed about the risks involved in the procedure.     

A highly specialized team led by Dr. Alkhalidi was formed to take on the delicate surgery. It was composed of Dr. Dirar Abdullah, Consultant Intensivist, Dr. Adel Al- Sisi, Specialist Intensivist, Dr. Dala, Specialist and Head of Department of Anesthesia, Dr. Sandeep, Specialist Nephrologist, and Dr. Bipin, Specialist and Head of Department of Radiology.

At 12:30 pm, the team began the operation and successfully performed the stenting procedure in just less than 20 minutes.  

Results

On the same day after the surgery, the patient passed around 12,000cc of urine and his general condition began to improve with his serum creatinine significantly declining. He was extubated the next day and was transferred to the general ward four days later. By this time, he could eat and walk without difficulty. The medical staff recorded his average urine output at 4 liters in 24 hours.  The patient was discharged the next day, with his serum creatinine level at 2.3 mg/dl. The successful surgery was made possible through sheared dedication and the tireless efforts of the entire team of doctors and medical registrars at Prime Hospital.