Stripping of glidewire - A rare intraoperative complication
A 32 year old male underwent PCNL for renal pelvic calculus extending into the middle calyx. A middle calyceal puncture was made by 18G initial puncture needle and 0.032 inch hydrophilic glidewire was passed through. The glidewire could not be safely parked into the pelvicalyceal system (PCS) because of impacted middle calyceal calculus. After repeated failed attempts to pass the guide wire into the collecting system, guide wire was removed with puncture needle in place. During removal the jacket of the glidewire got stripped and lost into the renal parenchyma. Another calyceal puncture was made and tract dilated and stone was removed. There was no endoscopic trace of the stripped glide wire in the PCS, though it was visible under fluoroscopy. Every calyx was searched but the stripped wire could not be identified. Procedure being carried under spinal anesthesia and a lot of time spent on searching the stripped glidewire, a DJ stent and nephrostomy tube was placed and procedure abandoned. Post operative X ray was showing the stripped glidewire coiled in the renal area. A non contrast CT scan revealed the stripped glidewire in the renal parenchyma near the middle calyx. After two days patient was again taken to Operation Theater after proper planning to remove the residual glidewire. Under fluoroscopic guidance the puncture was made directly on the stripped wire. A new glidewire was placed into the PCS under fluoroscopic guidance. Tract was dilated to 12 Fr and 8.5 Fr ureteroscope was passed through the sheath. The stripped wire was identified and removed intact. Postoperative period was uneventful.