To Pee or Not To Pee...

Case 1:
Male 38 years old, with chronic unilateral lumbar pain.
Lab investigations and urinalysis are within normal limits and ultrasound scan (USS) reveals significant abnormalities. A kidney-ureteric-bladder (KUB) X-ray and an intravenous urogram (IVU) investigation was carried out. An additional investigation, a retrograde pyelogram (RPG) was also done for confirmation of diagnosis. --- (KUB X-ray, IVU and RPG films were shown for us to figure out the diagnosis and treatment.)

Diagnosis:
Stenosis of ureteropelvic junction (UPJ) with congenital hydronephrosis of the left kidney with secondary multi-caliceal stones in the left kidney, and a caliceal stone in the right kidney.

Treatment:
- Ureteropyeloplasty / Endopyelotomy to relieve the UPJ obstruction.
- ESWL (exracorporeal shock wave lithotripsy) to remove the stones.

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Case 2:
Female 60 years old, admitted in emergency due to excruciating renal colic pain. Patient was given medications for the renal colic and the pain subsided. USS reveals significant unilateral abnormalities. A KUB X-ray and IVU was carried out for further confirmation of diagnosis. --- (KUB X-ray and IVU films were shown to us for diagnosis and treatment)

Diagnosis:
Ureterohydronephrosis on the right side with stenosis of the right ureter due to a ureteric stone in the pelvic ureter.

Treatment:
- Retrograde ureteroscopy (method of choice) / ESWL - to remove the ureteric stone
- Ureterolithotomy (if other procedures are unsuccessful)


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Well, there you go. That was the clinical cases for our group. Quite confusing especially when the stenosis and stones could be over-looked if one wasn't looking for it properly. I guess my decision to focus more on the urinary tract calculi chapter really did paid off. But it was kind of unexpected because whilst other 2 groups had 2 very different cases (renal tumor, horse-shoe kidney, bilateral hydronephrosis, Staghorn stone) ours we had both hydronephrosis and stones. So therein lies the confusion and misdiagnosis for some of my colleagues. Can't blame them though, it was just luck that made me see those tiny little opaque stones on the films and figured out what they were. Alhamdulillah, I am as ever thankful for the grace of Allah and humbled by His love and generosity...

And that marks the end for urology chapter. One thing for sure, I don't think I'm cut out to be a urologist. And if there's one thing that I would eternally remember from all this, it would be.... Priapism!! ^_^


Next up: Anaesthesiology and Intensive Care.


Two more exams and then we're done! Yippeeeee!!!