TP HCMMr. An, 74 years old, had a urinary tract infection that did not go away for a long time. The doctor discovered a mass of coral stones in his left kidney, 10×5 cm in size, with many branches resembling a ginger root.
Mr. An, living in Dong Nai, had a small stone in his left kidney about 6 years ago, occasionally had pain in his back and hips, and had not received treatment. About two months ago, he suddenly had a fever and chills all over his body. He went to the local hospital for emergency treatment and was diagnosed with a urinary tract infection. He was treated with antibiotics for three weeks but did not recover. He went to Tam Anh General Hospital in Ho Chi Minh City for examination.
On April 17, master, specialist II Pham Thanh Truc, Department of Urology, Center of Urology – Nephrology – Andrology, said that the patient’s left kidney had a mass of coral stones measuring 10×5 cm, completely filling it. Large kidney calyces, many branches weaving into small kidney calyces. The entire block of gravel resembles a large ginger root. This is the reason why he couldn’t cure his urinary tract infection for a long time.
He needs to be treated for the infection and have the stone removed early to avoid causing kidney infection, worsening chronic kidney failure, and death if bacteria enter the bloodstream.
Open surgery and percutaneous lithotripsy are two preferred options for large coral stones. However, Mr. An has many underlying diseases, especially stage 3 chronic kidney failure. If open surgery is performed, kidney function will be seriously damaged. In case the function of the kidney without stones is severely reduced, open surgery causes the patient to increase the level of kidney failure and require hemodialysis.
The mass of coral stones is large and has a complex structure. Open surgery may not remove the stones in one go and poses many risks to the patient. Therefore, doctors choose percutaneous endoscopic nephrolithotomy (PCNL).
Dr. Truc evaluates this as a modern kidney stone treatment method, giving priority to treatment of large stones over 2 cm, complex stones, and coral stones.
Through a very small “tunnel” (0.5 cm) from the back straight to the patient’s kidney pelvis, endoscopic and laser lithotripsy tools are inserted to break up the stones and then suck them out. Percutaneous lithotripsy is less invasive, less affecting kidney function, less painful, and patients recover quickly.
The doctor places a ureteral catheter (a tube that carries urine from the kidney to the bladder) to drain all infected urine from the kidney. After a week of treatment, the urinary tract infection stabilized, Mr. An had the stone removed.
Because the stone mass is too large, if crushed in one go, the treatment time will double (about 360 minutes), and there is a risk of upstream infection, which is not beneficial for patients with chronic kidney failure with a history of urinary tract infections such as grandfather. Dr. Truc divided the lithotripsy treatment into two sessions, one month apart, to completely clean the kidney stones while ensuring the patient’s health.
Thanks to the support of many machines, doctors can easily check the renal pelvis during the lithotripsy process and remove all stone fragments after treatment. “Coral stones are easy to recur, just a small fragment left behind can develop into a new mass of stones,” said Dr. Truc.
After two times of crushing, the large stone inside his left kidney was completely clean, and kidney function was preserved. Two days after surgery, he recovered, had no pain, walked, ate normally and was discharged from the hospital.
Dr. Truc broke the stones through the skin for Mr. An. Image: Tam Anh General Hospital
Dr. Truc said that every month the hospital’s Urology Department treats about 20 cases of kidney stones with various degrees of kidney stones. Depending on the level and type of kidney failure (acute or chronic), the doctor will prescribe appropriate treatment methods. Kidney stones account for less than 2% of the causes of end-stage chronic kidney failure, but the majority of cases are infected stones.
Coral stones grow silently over a long period of time, do not cause blockage of the ureter, so even if there are large stones in the kidney, the patient usually does not have back pain like other types of kidney stones. It is difficult to recognize and is only discovered by chance. During a health check, X-rays and ultrasound of the urinary system are required.
Dr. Truc recommends that people with urinary tract infections that do not heal after long treatment, frequent urination, high fever, chills, and unusual weight loss need to go to the hospital for examination and early treatment; Avoid leaving it for a long time to develop dangerous complications with kidney function and life.
To prevent coral stones, doctor Thanh Truc advises people to drink 1.5-2 liters of water per day, limit animal protein intake; salt; foods rich in oxalates (spinach, white radish, chocolate); Avoid holding urine for too long, have regular health check-ups every 6-12 months.