Abstract
Clinical History: A 38-year-old transgender female with history of HIV, bilateral orchiectomy, bilateral breast and buttock augmentation, and kidney stones presented for surgical evaluation of right nonobstructing kidney stones. CT scan showed two nonobstructing stones in the right lower pole measuring 8 and 7 mm. She specifically requested no ureteral stent and nonprone positioning because of recent facial plastic surgery. She elected to proceed with supine minipercutaneous nephrolithotomy (PCNL). There are several special considerations that should be taken when performing PCNL on transgender patients. Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and negative for costovertebral tenderness. Diagnosis: Right lower pole nonobstructing kidney stones. Intervention: A supine mini-PCNL was performed to accommodate patient's recent facial surgery and aversion to ureteral stent placement. In the Galdakao-modified Valdivia supine position, access was obtained using combined fluoroscopic, ultrasound, and endoscopic approaches. Access site was dilated to 18F, and the stones were extracted without incident. A retrograde flexible ureteroscope was used to evaluate all calices and confirm that no additional stones were present. A 14F nephrostomy tube was placed and no ureteral stent was left. Follow-up: Patient effectively underwent surgery without complication and was sent to post-anesthesia care unit (PACU) postoperatively where she recovered well. She was observed overnight for pain control. On postoperative day 1, the nephrostomy tube was clamped and there was confirmed urinary drainage in the foley. The nephrostomy tube and foley catheter were removed. She was instructed on wound care and informed to follow-up for her postoperative visit. Follow-up renal bladder ultrasound (RBUS) confirmed that she was stone free. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure No competing financial interests exist. Runtime of video: 4 mins 51 secs
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