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PREOPERATIVE DIAGNOSIS: Right renal stone.

POSTOPERATIVE DIAGNOSIS: Right renal stone.

PROCEDURE: Right shockwave lithotripsy, cystoscopy, and stent removal x2.

ANESTHESIA: LMA.

ESTIMATED BLOOD LOSS: Minimal. The patient was given antibiotics preoperatively.

HISTORY: This is a 47-year-old male who presented with right renal stone and right UPJ stone. The right UPJ stone was removed using ureteroscopy and laser lithotripsy and the stone in the kidney. The plan was for shockwave lithotripsy. The patient had duplicated system on the right side. Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE was discussed. Options such as watchful waiting, passing the stone on its own, and shockwave lithotripsy were discussed. The patient wanted to proceed with the shockwave to break the stone into small pieces as possible to allow the stones to pass easily. Consent was obtained.

DETAILS OF THE OPERATION: The patient was brought to the OR. Anesthesia was applied. The patient was placed in the supine position. Using Dornier lithotriptor total of 2500 shocks were applied. Energy levels were slowly started at O2 increased up to 7; gradually the stone seem to have broken into smaller pieces as the number of shocks went up. The shocks were started at 60 per minute and slowly increased up to 90 per minute. The patient's heart rate and blood pressure were stable throughout the entire procedure.

After the end of the shockwave lithotripsy the patient was placed in dorsal lithotomy position. The patient was prepped and draped in usual sterile fashion and cystoscopy was done. Using graspers, the stent was grasped x2 and pulled out, both stents were removed. The patient tolerated the procedure well. The patient was brought to recovery in stable condition. The plan was for the patient to follow up with us and plan for KUB in about two to three months.

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