Location
Philadelphia, PA
Start Date
11-5-2022 1:00 PM
End Date
11-5-2022 4:00 PM
Description
Objective:
This case study presents an adult with complete unilateral duplication of the renal collecting system and ureterocele who developed upper pole hydronephrosis secondary to urolithiasis which was ultimately treated with holmium laser ablation.
Case Presentation
A 49-year-old female presented to the emergency department (ED) with left flank pain. Non-contrast computerized tomography (CT) imaging revealed complete duplication of the left renal collecting system with severe upper pole hydronephrosis and multiple urolithiasis measuring approximately 5.9 x 2.2 x 1.7 centimeters (cm) in the left distal ureter. A distal left ureteral 3.3 x 2.3 x 2.3 cm ureterocele was also seen in the posterior bladder on CT imaging. Urine cultures grew Pseudomonas and Citrobacter so the patient was started on ciprofloxacin per antibiotic sensitivities. The patient was admitted for observation and treatment due to her radiologic findings and urinary tract infection (UTI). Interventional radiology (IR) was consulted to place a left percutaneous nephroureteral stent for decompression of the renal collecting system; however, the distal ureter was unable to be accessed so a left percutaneous nephrostomy (PCN) tube was placed. The patient was tolerating her medication and in stable condition and was discharged on oral antibiotics.
Approximately two months later, the patient returned to the hospital for endoscopic unroofing of the ureterocele detected on previous CT imaging. Intraoperatively, the lower pole ureteral orifice was initially seen, and a ureteric stent was inserted to protect this segment. The holmium laser was then used to incise the medial aspect of the ureterocele until the upper pole ureteral orifice was visualized. Once opened appropriately via holmium laser ablation, over approximately 100 smooth, round stones were evacuated from the ureter and ureteral stents were placed in both left ureters corresponding to the upper and lower pole segments. Approximately seven weeks postoperatively, the patient had both stents removed in the office, with a negative culture obtained prior to removal. Her final stone composition resulted as 10% calcium oxalate dihydrate, 45% calcium oxalate monohydrate, and 45% carbonate apatite. Total weight of the stones measured 7.5 grams in aggregate size.
Embargo Period
6-1-2022
Included in
Holmium Laser Unroofing of Ureterocele and Removal of Hundreds of Stones from an Adult Duplicated Kidney: Case Report
Philadelphia, PA
Objective:
This case study presents an adult with complete unilateral duplication of the renal collecting system and ureterocele who developed upper pole hydronephrosis secondary to urolithiasis which was ultimately treated with holmium laser ablation.
Case Presentation
A 49-year-old female presented to the emergency department (ED) with left flank pain. Non-contrast computerized tomography (CT) imaging revealed complete duplication of the left renal collecting system with severe upper pole hydronephrosis and multiple urolithiasis measuring approximately 5.9 x 2.2 x 1.7 centimeters (cm) in the left distal ureter. A distal left ureteral 3.3 x 2.3 x 2.3 cm ureterocele was also seen in the posterior bladder on CT imaging. Urine cultures grew Pseudomonas and Citrobacter so the patient was started on ciprofloxacin per antibiotic sensitivities. The patient was admitted for observation and treatment due to her radiologic findings and urinary tract infection (UTI). Interventional radiology (IR) was consulted to place a left percutaneous nephroureteral stent for decompression of the renal collecting system; however, the distal ureter was unable to be accessed so a left percutaneous nephrostomy (PCN) tube was placed. The patient was tolerating her medication and in stable condition and was discharged on oral antibiotics.
Approximately two months later, the patient returned to the hospital for endoscopic unroofing of the ureterocele detected on previous CT imaging. Intraoperatively, the lower pole ureteral orifice was initially seen, and a ureteric stent was inserted to protect this segment. The holmium laser was then used to incise the medial aspect of the ureterocele until the upper pole ureteral orifice was visualized. Once opened appropriately via holmium laser ablation, over approximately 100 smooth, round stones were evacuated from the ureter and ureteral stents were placed in both left ureters corresponding to the upper and lower pole segments. Approximately seven weeks postoperatively, the patient had both stents removed in the office, with a negative culture obtained prior to removal. Her final stone composition resulted as 10% calcium oxalate dihydrate, 45% calcium oxalate monohydrate, and 45% carbonate apatite. Total weight of the stones measured 7.5 grams in aggregate size.