An aggressive surgical approach to remove calculi in the kidney and ureter is, in most cases, the usual means by which to manage this problem. Dr Olsson's comments reflect proper present-day urologic protocol, with which we are in total agreement. All aspects of the patient's care, however, could not be discussed because of the space limitation of a case report. In fact, surgery had already been carried out in our patient and had failed, with recurrence of stones and infection. Furthermore, this patient was and is in the final stages of his disease, for which no appropriate therapy has yet been defined. Irrigation of the renal pelvis to attempt stone dissolution was initiated for the following reasons: First, as noted in the case report, bilateral renal disease was present, and further surgery with the possible consequence of a total nephrectomy would have been a hazard to the patient's
Jenny DB, Goris GB, Urwiller RD, Brian BA. Irrigation of Renal Pelvis-Reply. JAMA. 1979;241(14):1463–1464. doi:10.1001/jama.1979.03290400023011
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