15th July 2024

A 28-year-old woman with poorly controlled T1DM is referred by her GP

A 28-year-old woman with poorly controlled T1DM is referred by her GP to the acute medical unit at 3am. On arrival, she is alert, however complaining of flank pain on the right. She also complains of haematuria for the last 3 days. RR is 22, SpO2 93% OA, HR 133, BP 99/55, Temp 38.8 degrees Celsius. A venous gas shows pH of 7.21, plasma glucose of 33 and lactate of 4.1. WCC are 23, Hb is 134, CRP is 290. Other blood tests include Na 134, K 6, Ur 22, Cr 400, eGFR 15. A urine dip is positive for blood (+++), protein (++), leucocytes (++) and nitrites (+++). A CT-KUB shows a right sided large proximal calculus (39mm), with a further stone in the distal ureter, with significant hydronephrosis.

She is discussed with urology and interventional radiology who have reviewed. They plan intervention. What is the most likely intervention she will have?

Select the SINGLE most appropriate option from the list below. Select ONE option only.