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>> Callen woke up one night in the middle of the night,
screaming in pain, he was complaining of lower pain in his stomach.
>> In the beginning, I thought it was just going to be like a stomach thing,
stomach virus and obviously it turned out to be a little more complex than that.
>> I never even considered kidney stones as being, something that a five-year-old would have.
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>> One may not know they have stones in the kidney, even a very large stone,
but the times where it comes to light is where that stone, for many different reasons, may move,
it may grow and cause changes. And some of those symptoms that you typically see,
could be anything from blood in the urine to pain, to nausea/vomiting, to fever.
>> We took him to the emergency room and they did all kinds of tests and
they said that he didn't have appendicitis, but they wanted to take more scans just to
rule out any other problems, and that's when they said he had kidney stones.
>> When I met Callen, he had a known kidney stone for which he had undergone
two procedures before arriving at CHOP. First, shockwave lithotripsy, and then ureteroscopy
and neither of those procedures were able to successfully remove the stone.
>> We decided to come here for the second opinion and it was a homerun. Dr. Tasian explained
everything, he had all his models and diagrams in the room with him, and a lot more informative
in our first visit here then all of the previous visits with the other doctor.
>> At CHOP we really believe in shared decision-making where I, as a urologist,
can present those options and then work with the patient and their family and their caregivers
to decide about the surgery that works best for them.
Callen had a horseshoe kidney, and a horseshoe kidney is exactly what it sounds like. So
the lower part of the kidney, the, what's called the lower poles, are joined together
so that the kidney is shaped like a horseshoe. And that configuration can make surgery
quite challenging because the kidneys are oriented in a different way. In understanding his history,
and in Callen's case, getting a CT to better understand what the kidney anatomy looked like.
After counseling, percutaneous nephrolithotomy was the clear choice for him because, both of
the inability to remove those stones from the prior procedures, as well as the way his kidneys
were shaped, and where that stone was located at the very bottom of this horseshoe kidney.
>> We were presented with options and Dr. Tasian obviously shared what
his thoughts were on which treatment option was going to be the best for Callen.
>> He was also able to share
the case with colleagues and get their opinions on the best way to tackle it and treat it.
>> Everybody seemed to believe that we would get most success from PCNL.
>> Percutaneous nephrolithotomy is done for a large stone in which the
the clearance may be lower for ureteroscopy or shockwave lithotripsy.
And this is the procedure that is performed the least commonly
but it has an essential place in the treatment of stones in both children and adults
and percutaneous nephrolithotomy is done through a very small incision in the back
or the flank. And that's typically less than a centimeter. And through that incision a sheath,
a conduit can be placed into the kidney, and then through that conduit,
a larger scope can be placed directly into the kidney, and then that stone can be removed in
its entirety after breaking it up. After a PCNL, usually some temporary urinary drainage is needed,
whether it's a stent or a nephrostomy tube that directly drains urine from the kidney.
>> We were told to go to the family room where Dr. Tasian came out and gave us the news that it went
as well as can be expected and everything was going good. And we were going to get to go see
him in a little bit as he was in the recovery room and starting to wake up. Stayed two nights,
so the first night he had a drain sticking out of his left side, there for the kidney. No problems.
The next day they took the drain out and everything and he was good to go. He was like,
"Oh, let's go to the snack bar. Let's go get ice cream." So within 30 hours he was
ready to roll.
>> We weren't sure if he would come home with a nephrostomy tube,,
or if that would be something that would be removed before we left.
Obviously we were hopeful that it would be removed before we left and that's exactly what happened.
He's been so much better. It's a little tough to get the the diet thing in check.
Other than that, we've had no issues since the surgery. And he's had no pain, no discomfort,
no complaints. Just back to being himself again.
>> To be able to see those changes rather quickly is
something that I personally find very gratifying.
>> I feel better now.
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