Stone removal was done with the minimally invasive procedure of endoureteral electrokinetic lithotripsy. The postoperative follow-up showed some small remaining concrements. ESWL was not performed due to medullary nephrocalcinosis on renal ultrasound. Stones had been removed from the right kidney in 1983 and 1993 in Libya. Plain abdominal x-ray upon admission showed a renal calculus 4 cm in diameter in the pelvis of the left kidney and two smaller stones on the right side.
Stone fragments one day after right-sided pyelolithotomy and ureterolithotomy.
Liver biopsy was not performed. Percutaneous nephrolithotripsy and nephrostomy on the left side were performed, and the whole concrement was removed. On the right side stones were left in situ. ESWL was not performed because medullary nephrocalcinosis was suspected. Primary hyperoxaluria has to be differentiated from secondary forms, e.g., in chronic inflammatory bowel disease, or after ileum resection, when malabsorption of fatty and bile acids leads to an increase in oxalate absorption.