Renal Papillary Necrosis

55 years old lady who is known to have uncontrolled diabetes mellitus type II with chronic renal failure, who presented two episodes of acute left obstructive pyelonephritis in one year.
CT KUB (without IV contrast because of high creatinin level in blood) done twice showed left hydronephrosis with undefined left ureteral obstruction.
First episode one year ago, patient was operated with left JJ INSERTION then removal of JJ stent one month later without further exploration of the left ureter and left collecting system.
Recently patient presented with urosepsis with a second episode of acute left obstructive pyelonephritis, JJ stent was inserted as a life saving procedure. Exploration of the left collecting system one month later by flexible ureteroscopy showed tissue in the left upper calyx.
This tissue was sectioned by laser fiber 365 microns with intensity of 1,5 J and frequency of 10 Hz. Pieces of tissue were removed with Dormia Basket and left collecting system was completely clean at the end of the procedure.
Laser time: 10 minutes
Operation time: 1 hour
Blood loss: insignificant

Histopathology: necrotic tissue, consistent with papillary necrosis tissue.

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