A case of a lower pole renal calculus managed with percutaneous nephrolithotomy.

BACKGROUND

A 50-year-old man presented to an outpatient urology clinic with left-sided flank pain. He had received treatment for a left renal pelvis calculus 5 years earlier; shock wave lithotripsy had been unsuccessful and ureteroscopic laser lithotripsy had left the patient with a 2 mm residual stone fragment. The fragment was deemed clinically insignificant, and the patient remained asymptomatic without any further follow-up.

INVESTIGATIONS: Physical examination, CT of the abdomen and pelvis, and complete metabolic evaluation.

DIAGNOSIS: Left lower pole renal calculus and idiopathic hypercalciuria.

MANAGEMENT: The patient was counseled about his treatment options, and he elected to undergo percutaneous nephrolithotomy. After a single-stage procedure, CT confirmed a stone-free state. The patient was administered thiazide therapy and dietary counseling to treat his hypercalciuria. This condition resolved, and the patient remained stone-free 1 year after treatment.