V04-11: The challenging case of a stag horn cystine stone and a dislocated ureteral stent in a 18-month-old patient: Vacuum-assisted mini-pcnl and robotic surgery to the rescue.
Introduction: We present the case of an 18-month-old female patient brought to the emergency department of a foreign hospital due to anuria. She was diagnosed with bilateral staghorn kidney stones and Acute Kidney Injury (AKI) (Creatinine 5.47 mg/dL) and underwent bilateral ureteral JJ stent placement. Methods: The patient was then referred to our centre where we performed a low-dose CT scan, documenting bilateral staghorn stones and dislocation of the proximal end of the right stent in the retroperitoneum. We planned a vacuum-assisted right-sided mini-PCNL (16 Ch ClearPetra set, 12 Ch MIP Storz endoscope and 550 um Ho:YAG laser fiber) and endoscopic JJ stent removal. Results: We achieved complete clearance of the urolithiasis and visualised the site of exit of the JJ stent from the ureter, 1-2 cm below the ureteropelvic junction. Unfortunately, we were unable to safely remove the device endoscopically as the proximal pigtail appeared to be stuck and very close to major vessels when pulling the distal end with endoscopic graspers under fluoroscopic vision. We reported no post-operative complications. The stone composition was cystine 100%. A week later we performed a robot-assisted procedure with a transperitoneal approach to remove the dislocated JJ stent. Removal under direct vision was possible. Few weeks later, a left mini-PCNL was performed to obtain complete stone removal. Conclusions: The use of miniaturised vacuum-assisted technologies and robotic-assisted surgery greatly aids in the management of complex cases, especially in very young children affected by cystine stones, for whom reducing invasiveness is paramount. SOURCE OF Funding: no
