Good

Morning
Case Presentation

Dr. Fouzia khan

Intern doctor
Department of Urology
Dhaka Central International Medical College and Hospital
Particulars of the patient
• Name :Md. Masum
• Age: 30 years
• Sex: Male
• Religion : Islam
• Marital status: Unmarried
• Occupation : Construction worker
• Address : Dakkhin khan
• Date of admission: 20/12/22
• Date of examination: 20/12/22
Chief complaints

• Pain in left loin for 6 months.

History of present illness

• According to the statement of the patient, he was

reasonably well 6 months back. Then he developed
pain in left loin which was colicky in nature, radiating
from loin to groin, occasionally pain radiates to tip of
penis and testis, moderate to severe intensity,
associated with hematuria for single episode and
occasional burning micturition, there is no specific
aggravating and relieving factor. For this pain he took
some medications. After taking medications pain was
relived.
• There is no history of calcuria, pyuria, fever,
chest pain, bone pain, cough, hemoptysis, weight
loss or contact with TB patient .
History of comorbidity

• Normotensive
• Non diabetic
• No history of other medical illness
Drug History

• Nothing contributory
Personal history

• He is non-smoker and non-alcoholic .

Family history

• None of his family members are suffering

from such kind of illness.
Socioeconomic history

• He belongs to middle class family

Immunization history

• He was vaccinated according to EPI schedule.He

took 3 doses of vaccine against covid-19.
General Examination
• Appearance: ill looking
• Body built: Average
• Anemia: Absent
• Jaundice : Absent
• Oedema: Absent
• Blood pressure: 120/80 mm of Hg
• Pulse: 88 bpm
• Temparatue: 98 F
• Respiratory rate: 18 breath/min
• Lymph nodes: No accessible lymph nodes are palpable
Systemic examination

Genitourinary system and abdomen

• Abdomen normal in shape

• Flanks not full
• Umbilicus centrally placed and inverted
• Hernial orifices intact
• No scar mark
Genitourinary system and abdomen
(continued)

• Kidneys not palpable

• Renal angle tenderness absent
• Suprapubic region was non-tender and not full
Genitourinary system and abdomen(continued)

• EUM: Normal
• Palpable part of urethra : Normal
• Testes: Normal
• Epididymis: Normal
• Vas deferens: Normal
• Scrotum: Normal

• DRE: Normal finding

Other systemic examination reveals
normal findings
Salient feature

• Md. Masum, 30 years old male, Muslim, normotensive, non-

diabetic , non-smoker , non-alcoholic, construction worker,
hailing from Dakkhin khan, Dhaka, presented with pain in
left loin for 6 months which was colicky in nature. Radiating
from loin to groin, occasionally pain radiates to tip of penis
and testis, moderate to severe intensity, associated with
hematuria for single episode and occasional burning
micturition, there is no specific aggravating and relieving
factor. For this pain he took some medications. After taking
medications pain was relived.
Salient feature

• General examination and genitourinary system

examination reveals normal findings. Other systemic
examination reveals no abnormality.
Diagnosis
Provisional diagnosis

• Left ureteric stone.

Differential diagnosis

• Vesical calculus
Investigation

• Urine R/M/E
• Urine C/S
• S. creatinine
• USG of KUB
• Non-contrast CT scan of KUB region
• CBC
Complete blood count

• Hb%: 14.8gm/dL
• RBC: 5.25 M/cmm
• WBC: 10,730/cmm
• Platelet count: 348,000/cmm
Urine RME:
• Colour : straw
• Pus cell : 12-15
• Epithelial cell : 0 - 2/HPF

Urine C/S:
• No growth found

Serum creatinine
• 1.28 mg/dL
USG of KUB
• Kidney: Pelvicalyceal system of
left
• Kidney and left ureter is mildly
dilated .
• COMMENT: Left sided
hydroureteronephrosis.
X-RAY PLAIN KUB

• Radio-opaque shadow seen in the left side

of the pelvic cavity opposite to the ischial
spine.
IMPRESSION: SUGGESTIVE OF LEFT VUJ
CALCULUS.
 Non-Contrast CT of KUB

LEFT KIDNEY, PC SYSTEM, URETER:

Tiny hyperdense structures (at least 2), larger one
measuring about 8mm seen at left VUJ causing
proximal dilatation of ureter & PC system.
Confirmatory diagnosis

• LEFT SIDED VUJ STONE

Treatment

• Left URS with ICLL with DJ Stenting

• Perioparetive period was uneventfull.
• Patient was discharged on 3rd POD
• Next plan-removal of stent after 4 weeks