From the Research
The next step in managing this patient is immediate urological intervention to relieve the obstruction caused by the UPJ stone while simultaneously controlling the autonomic dysreflexia, and the most appropriate initial intervention is urgent decompression of the urinary tract via placement of a retrograde ureteral stent. The patient should undergo this procedure to alleviate the obstruction and prevent further episodes of autonomic dysreflexia. Prior to the procedure, blood pressure should be controlled with rapid-acting antihypertensives such as intravenous labetalol (10-20 mg) or sublingual nifedipine (10 mg) 1. During the procedure, continuous blood pressure monitoring is essential, and the patient should receive prophylactic antihypertensive medication. The procedure should be performed under adequate anesthesia to prevent triggering further autonomic dysreflexia. Following decompression, definitive stone management can be planned as a second-stage procedure using ureteroscopy with laser lithotripsy or percutaneous nephrolithotomy depending on stone characteristics, with percutaneous nephrolithotomy (PCNL) showing the highest success and stone-free rate in the surgical treatment of renal stones 1. Some key points to consider in the management of this patient include:
- The importance of urgent intervention to prevent further episodes of autonomic dysreflexia, which can be life-threatening 2.
- The need for careful blood pressure control during the procedure to prevent triggering further autonomic dysreflexia 1.
- The use of adequate anesthesia to prevent triggering further autonomic dysreflexia 3.
- The consideration of PCNL as a definitive stone management option due to its high success and stone-free rate 1.