Percutaneous puncture nephrostomy on the back of a patient with an external fixation apparatus on the bones of the pelvis following a road traffic accident

Abstract

The article presents a rare clinical case of renal colic with a stone in the lower third of the ureter in the patient after a traffic accident with an external fixation device on the pelvic bones. A 41-year-old patient was hospitalized to the emergency urology department of the City Hospital No. 5 of Naberezhnye Chelny in 2019 with renal colic on the right. An ultrasound revealed right pelvocaliectasis of kidney. Pelvic survey (urogram) shows the shadow (9 mm in diameter) suspicious for renal calculus in the projection of the lower third of the right ureter. The pain was not relieved by analgesics. It was unsuccessfully attempted to stent the right ureter due to insurmountable obstacle at a distance of 4 cm from the ureteral orifice. Due to technical complexity (laying the patient in a lithotomy position and on the stomach or side was impossible due to a possible breakdown of the external fixation apparatus on the pelvic bones) percutaneous puncture nephrostomy was performed under ultrasound control in the supine position according to emergency indications. The pain was relieved. The patient was discharged home. After one month, the external fixation device for the pelvic bones was removed. The patient was hospitalized again. Ureteroscopy and contact ureterolithotripsy on the right ureter were performed routinely. Nephrostomy was removed. The patient recovered. The described case is of clinical interest as a rare combination of renal colic and the presence of an external fixation apparatus on the bones of the pelvis, which causes additional difficulties for the drainage of the urinary tract. Percutaneous puncture nephrostomy on the back with a roller in the ipsilateral kidney is a good alternative for urologists when to lay the patient on the stomach or side is impossible.