A special skin-to-skin stone dissection was successfully performed by doctors of the Department of Urology and Andrology, E Hospital for a 65-year-old male patient in a state of severe scoliosis and complex anatomical deformity of the spine.
The patient suffers from persistent adhesive spinitis for many years, causing the body to be almost stiff and unable to lie straight. The kidney is in an abnormal position, "climbing" close to the chest, while the ribs are narrow, causing the path to the stone to be almost "locked". Even a small mistake in the intervention process can lead to the risk of pleural damage, bleeding, or technical failure.
Dr. Nguyen Dinh Lien - Head of Urology and Andrology Department, E Hospital said that the patient was admitted to the hospital in a state of severe back pain on both sides, prolonged body fatigue due to kidney stones and ureteral stones causing urinary tract obstruction.
Through examination and diagnostic imaging, doctors determined that the patient had hydronephrosis due to kidney stones and ureteral stones causing blockage. However, what makes the case particularly complicated is the severe scoliosis that has existed for many years.
According to medical history, the patient had a traffic accident nearly two decades ago. After the accident, the spine gradually deformed seriously, the body became more and more flexible and lost the ability to move normally. For the past 18 years, he has almost had to live with prolonged pain, difficult living and declining physical condition.
About a year ago, the patient was again diagnosed with kidney stones. The family took him to many different medical facilities for examination, but due to old age, weak physical condition, complex spinal deformities and many underlying diseases, intervention and treatment were very hesitant.
The patient has very severe spinal deformities, the lying position is almost impossible to perform as usual. This is a factor that makes both anesthesia and surgery potentially risky," Dr. Nguyen Dinh Lien shared.
The first challenge appears right from the anesthesia and resuscitation stage. Usually, the patient will be placed lying on their back to perform endotracheal intubation for anesthesia. However, in this case, adhesive spinitis causes the cervical and back vertebrae to almost completely lose their mobility. The patient cannot lie straight but can only maintain a fixed flexed position, making airway control particularly difficult.
After successful anesthesia control, another challenge continued to appear right on the operating table.
Initially, doctors planned to perform retrograde endoscopy to treat ureteral stones. However, due to the protracted scoliosis of the spine causing the ureter to deform and bend abnormally, it was almost impossible to bring instruments to approach the stones.
Right on the operating table, the team under the command of Dr. Nguyen Dinh Lien decided to switch to crushing stones through the skin. However, challenges continued to appear when the kidney was very high, close to the chest, while the ribs were narrow, making the access to the renal pelvis extremely limited. Just a small deviation could cause lung damage or bleeding.
After many efforts, doctors created a safe access road and after only about 10 minutes of crushing stones, they successfully removed ureteral stones that caused prolonged obstruction, helping to release urinary tracts for patients.
According to Dr. Nguyen Dinh Lien, this is a rare case with anatomy changing almost completely, requiring close coordination between the anesthesia and surgical teams to ensure safety for the patient.
