Udaipur : In a challenging urological procedure, doctors at Paras Health Udaipur successfully treated a 33-year-old man suffering from multiple large staghorn kidney stones, chronic kidney disease (CKD) and severely reduced kidney function.

The medical team performed a single-stage, single-tract Percutaneous Nephrolithotomy (PCNL) and removed more than 500 stone fragments through a single access tract. The complex procedure was performed by Dr. Vishwas Baheti, Director of Urology, Paras Health Udaipur.

The patient was also suffering from bilateral renal calculi, meaning stones were present in both kidneys. He had previously undergone PCNL at another hospital and was admitted to Paras Health as a high-risk surgical candidate.

His condition was further complicated by severe kidney impairment and significant anaemia, with his haemoglobin level around 6 g/dL. He also required intermittent haemodialysis, raising concerns that dialysis might be needed following surgery.

Investigations revealed stones occupying all the calyces of the right kidney, the structures where urine collects before passing into the urinary tract.

A Carefully Planned High-Risk Procedure

Considering the patient's condition, the medical team first established urinary drainage through a right-sided Percutaneous Nephrostomy (PCN). A tube was inserted through the skin directly into the kidney to facilitate urine drainage.

This was followed by bilateral ureteric stenting, in which thin tubes were placed in both ureters to maintain urinary flow.

The team subsequently performed PCNL, a minimally invasive procedure in which a small access tract is created through the skin to reach the kidney directly. The stones are then fragmented and removed through this tract.

In this case, the surgeons successfully cleared the stones in a single stage using only one access tract, minimising the number of kidney accesses required despite the extensive stone burden and the patient's high-risk medical condition.

‘A Challenging Case’

Dr. Vishwas Baheti, Director of Urology at Paras Health Udaipur, said the case was particularly challenging because of the patient's chronic kidney disease, severely compromised renal function and haemoglobin level of approximately 6 g/dL.

The patient had also previously undergone PCNL and required intermittent haemodialysis, increasing the risks associated with surgery.

According to Dr. Baheti, the team opted for a single-stage procedure using only one tract to achieve complete stone clearance while minimising access to the kidney.

Despite the complexity and the patient's high-risk status, he did not require haemodialysis after the surgery.

Recovery Without Post-Surgery Dialysis

The patient showed significant improvement following the procedure and was discharged on the third day without any reported complications at the time of discharge.

According to the hospital, he is now doing well, has resumed work and no longer requires haemodialysis.

The patient expressed gratitude to Dr. Baheti and the Paras Health Udaipur team, saying that the severity of his kidney condition had been a major concern for him and his family. He said the medical team explained the treatment process clearly and provided support throughout his treatment, helping him regain confidence and return to his normal routine.

The case highlights the potential of single-stage, single-tract PCNL as a minimally invasive approach for managing a substantial stone burden in carefully selected high-risk patients, including those with severely compromised kidney function.