Operative situations
Red-out:
- Check irrigations, remove clots, increase irrigation height, check positioning (?is scope in collecting system, advance sheath)
- Nephrostomy clamped +/- nephromax or Kaye
- Anaesthetic involvement, resuscitation +/- transfusion
- Re-look with resectoscope and rollerball?
- Angioembolisation
- Nephrectomy
After gaining access, pus is drained:
- Send sample for culture
- Do not proceed with stone treatment
- Leave large nephrostomy tube for drainage
- IV antibiotics
- Proceed with stone treatment when infection treated
Looks like faeces:
- Contrast to confirm location ?in bowel
- Leave nephrostomy tube within lumen of colon
- Separate placement of stent +/- nephrostomy to ensure separate drainage of systems
- Abandon stone treatment
- Consider separate retroperitoneal drain
- Antibiotics, NBM/TPN and general surgeons