A Novel Approach for the Successful Ureteroscopic Management of Complicated Steinstrasse (Stone-Street) Resulting from Extracorporeal Shock Wave Lithotripsy (ESWL) of Staghorn Calculi

Abstract

A 39 year-old female with left staghorn calculi, who had been treated with two sessions of ESWL in another institution, was complicated by a renal hematoma, steinstrasse, and hydronephrosis. After receiving five units packed red cells, she was transferred to our institution for further management. The authors performed a percutaneous renal puncture to antegradely bypass the ureteral stones with a guidewire, and drained the obstructed system with a nephrostomy tube. The distal end of the guidewire, which exited the bladder, was exteriorized and used to gain easy retrograde access and perform ureteroscopic laser lithotripsy and ureteral stent placement. Throughout the procedure, the nephrostomy tube facilitated early drainage of the obstructive hydronephrosis and helped diminish the intrapelvic hydrostatic pressure throughout the ureteroscopic lithotripsy. An indwelling ureteral stent was placed after the procedure. Postoperative saline irrigation through the nephrostomy tube was done postoperatively which enhanced distal migration of the disintegrated stone fragments into the bladder and out through the urethra.

The total operative time was 150mins. The patient was discharged on postoperative day 2 without any complications. The ureteral stent was removed after one month. Postoperative retrograde pyelogram, ureteroscopy and CT scan showed no residual stones.

This novel approach allowed a single-stage endoscopic management of high-volume steinstrasse with achieved completed stone clearance without complications.