a man 56 yr old c/o hematuria off and on.no fever .no other problems. ivp normal but latest usg hydronephrosis.what is line of management

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Ad hydration therapy and diuretics, calculus will pass.

one of usg is reporting 10 mm stone in mid calyx and another 9mm at PUJ.The best approach would be pcnl through middle calyceal puncture through which we can deal both the stone....but final puncture planning can be done after seeing ivu film.

PLAIN XRAY ABD = STONE I V U URINE C &S CULTURE FOR AFB TO DETECT CAUSE FOR HYDRONEPHROSIS RX .ANTIBIOTIC AFTER URINE C& S

Hydrotherapy antibiotic and diuretics . Antispomsdic iand if not respond than lithotripsy

depends on pelvicalyceal anatomy on ivp images PCNL or RIRS or ESWL are the options

No role for conservative management here . As there is an obstructive 8 mm calculi at the puj and 1 cm middle calyx calculus with hydronephrosis.. I will give the patient 2 options..1. Retrograde intra renal surgery and lithotripsy ( RIRS ) 2. Extracorporeal shock wave lithotripsy ( ESWL ) If he's poor then he can go for a PCNL

Dr Raghavendra you mean to say that if he is poor pcnl would be option .Is pcnl cheaper than eswl or RIRS.
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t. oflox 400 bd syp neeri bd t. pan 40 bbf od t. meftal spac bd for next 5 days avoid seed items and junk food

I have seen 3 by 2 CMs stones passed by hydration therapy.

Plan for URS and DJ stenting. Till then Tab. Norflox 400 mg Tab. Urispas, Tab. Buscopan , Syp. Neeri

Probably eswl will work. Or pcnl/rirs depending upon patient's preference

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