Operating Endoscopically with "Two Hands" to Remove Calcified Permanent Suture After Pyeloplasty

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Pyeloplasty is a common surgical procedure for ureteropelvic junction obstruction.
• Permanent suture material used in urinary tract surgery can potentially lead to complications.
• Nephrolithiasis (kidney stone formation) is a known, though infrequent, risk after ureteropelvic junction repair.

Observation:

• A patient presented with flank pain and kidney stones 10 years after a laparoscopic pyeloplasty.
• The kidney stones were found to be encrusted around a permanent suture from the initial pyeloplasty.
• This highlights a rare but significant long-term complication associated with non-absorbable sutures in the renal pelvis.

Findings:

• A combined percutaneous and endoscopic surgical approach was effectively utilized for stone removal.
• This minimally invasive technique successfully extracted the encrusted permanent suture material from the renal pelvis.
• The procedure resolved the patient's symptoms and the source of stone formation.

Implications:

• This case demonstrates a viable treatment strategy for encrusted sutures and associated nephrolithiasis after pyeloplasty.
• It underscores the importance of avoiding non-absorbable suture materials in the urinary tract to prevent stone formation.
• The combined approach offers a less invasive option for managing such complex urological stone complications.