Successful Treatment of Kidney Stones and Hydronephrosis in a 72-Year-Old Male Using Holmium Laser Lithotripsy

Overview: Resolving Severe Hydronephrosis Caused by Renal Calculi

A 72-year-old male presented with right-sided flank pain and was diagnosed with significant right kidney hydronephrosis due to a large renal stone measuring 24×15mm. After undergoing minimally invasive holmium laser lithotripsy via flexible ureteroscopy, the obstructing stone was successfully fragmented and removed. Postoperative imaging confirmed complete resolution of both the stone and associated hydronephrosis. The patient recovered well during an 8-day hospital stay and reported full symptom relief at a 6-week follow-up visit.

Patient Profile & Clinical Background

Age/Gender: 72-year-old maleDiagnosis: Right hydronephrosis secondary to nephrolithiasis (kidney stones)Hospital: First Affiliated Hospital of Xi'an Jiaotong UniversityDate of Admission: February 2022Treatment Approach: Minimally invasive surgical intervention combined with intravenous antibiotics, fluid support, and oral stone-expulsion medicationTherapeutic Duration: 8 days inpatient care followed by outpatient monitoring for six weeksOutcome: Complete elimination of kidney stone and hydronephrosis, no residual symptoms, excellent recovery

Initial Evaluation: Identifying the Source of Flank Pain

The patient first became aware of a right kidney stone two months prior during a routine ultrasound and CT scan performed for coronary heart disease evaluation. He had attempted conservative management using unspecified herbal medications without success. One day before admission, he developed acute, intermittent colicky pain in the right flank area. Notably, there were no accompanying signs such as nausea, vomiting, or visible blood in the urine.

Upon physical examination, no abdominal distension was observed. However, tenderness and percussion pain were present at the right costovertebral and costolumbar angles—classic indicators of kidney involvement. There was no tenderness along the course of the ureters or over the bladder region.

Diagnostic Imaging Confirms Obstructive Uropathy

Renal ultrasound revealed a hyperechoic mass of 24×15mm within the right renal collecting system, with posterior acoustic shadowing—a hallmark feature of calculi. Additionally, a 19mm fluid-filled space indicated moderate hydronephrosis. In contrast, the left kidney showed normal architecture with no evidence of obstruction. Based on these findings, a definitive diagnosis of right nephrolithiasis complicated by hydronephrosis was established, warranting immediate intervention.

Therapeutic Intervention: Precision Laser Fragmentation of Kidney Stone

After discussing treatment options, the patient consented to surgery. Given his age and overall health status, a minimally invasive approach was selected to reduce complications and accelerate recovery. On the second day of admission, he underwent transurethral flexible ureteroscopic holmium laser lithotripsy under general anesthesia.

Surgical Procedure Highlights

During the procedure, a flexible ureteroscope was advanced through the urinary tract into the right kidney. A holmium:YAG laser fiber was then used to fragment the stone into small, passable pieces. To ensure proper drainage and prevent postoperative swelling-related obstruction, a ureteral stent was placed, and a urinary catheter was temporarily inserted.

Post-surgery, the patient returned to the ward stable. Intravenous therapy included:

- Cefuroxime sodium: Broad-spectrum antibiotic to prevent infection

- Metronidazole saline solution: Additional coverage against anaerobic pathogens

- Lactated Ringer's solution: For hydration and electrolyte balance

To enhance stone clearance, the patient was prescribed Shi Pai Granules (a traditional Chinese formula known for promoting urolithiasis expulsion) orally. He was also advised to increase daily water intake significantly to flush out residual fragments.

Recovery and Follow-Up Results

The patient tolerated the treatment well. Within two days, the urinary catheter was removed, and he resumed normal activities. His flank pain gradually subsided, and he experienced no urinary urgency, frequency, or dysuria. Throughout his 8-day hospitalization, vital signs remained stable, appetite improved, and sleep quality was satisfactory.

Discharge Assessment and Imaging Confirmation

Prior to discharge, another physical exam showed no costovertebral angle tenderness or bladder discomfort. Repeat ultrasound demonstrated complete absence of the previous stone and resolution of hydronephrosis. All other findings were unchanged and within acceptable limits.

At the 6-week follow-up, imaging confirmed sustained remission with no recurrence. The ureteral stent was successfully removed, and the patient reported total relief from back pain. No further interventions were required, and he resumed regular daily life with appropriate lifestyle modifications.

Key Recovery Guidelines for Patients After Kidney Stone Surgery

Given the patient's advanced age and higher risk of recurrence, thorough discharge counseling was provided to optimize long-term outcomes:

• Increase Fluid Intake: Aim for 2,000–3,000 mL of water daily to maintain high urine output and reduce mineral crystallization.
• Avoid Strenuous Activity: Refrain from heavy lifting or intense exercise that increases intra-abdominal pressure, which could disrupt healing.
• Balanced Rest and Activity: Prioritize adequate rest while engaging in light walking to promote circulation and recovery.
• Nutritional Adjustments: Focus on vitamin-rich foods, lean proteins, and high-fiber vegetables. Limit spicy, salty, and processed foods that may contribute to stone formation.
• Regular Monitoring: Attend scheduled check-ups to assess kidney function and detect early signs of recurrence. Seek prompt medical attention if new symptoms arise, including pain, fever, or changes in urination.

Clinical Insights: Addressing the Root Cause of Hydronephrosis

This case illustrates how obstructive uropathy—particularly when caused by kidney stones—can lead to progressive renal dilation and potential loss of kidney function if left untreated. While tumors and strictures are also common causes, nephrolithiasis remains one of the most frequent etiologies of hydronephrosis in older adults.

Why Early Intervention Matters

By removing the mechanical blockage—the kidney stone—we effectively reversed the downstream effects, including hydronephrosis. This highlights a key principle in urology: relieving urinary obstruction often leads to rapid improvement in kidney structure and function. Modern techniques like holmium laser lithotripsy offer high precision, minimal invasiveness, and fast recovery times, making them ideal for elderly patients who may not tolerate open surgery.

Moreover, this case emphasizes the importance of comprehensive postoperative care, including hydration, dietary guidance, and structured follow-up, all of which play critical roles in preventing recurrence and supporting long-term kidney health.