PMC5927814_01
Left vesicoureteral junction stone and the right staghorn stone.
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Abdominal x-ray showed semi radiopaque stone in the area of the bladder and another semi radiopaque stone in right kidney (Fig. 1).
Left-sided moderate hydronephrosis and the right-sided staghorn.
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It also showed a right staghorn stone filling the right renal pelvis and lower calyces measuring 2.7 x 3.2 cm causing moderate right hydronephrosis (Fig 2, Fig. 3).
Bladder ultrasound showing the ureterocele and the stone inside.
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Urinary tract ultrasound showed the ureterocele and the stone within (Fig. 4).
Endoscopic image showing the left ureterocele.
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The patient was put in lithotomy position, a 22F cystoscope was introduced into the bladder, the right ureteric orifice was identified and a large left intravesical ureterocele was seen with no apparent left ureteric orifice noticed which goes with the fact that most intravesical ureteroceles have stenotic orifices (Fig. 5, Fig 6), then a 24F resectoscope was inserted, deroofing of the ureterocele with cutting current was performed and the stone was visualized and nudged with the loop into the bladder (Fig. 7, Fig 8, Fig. 9, Fig. 10).
Endoscopic image showing the large left intravesical ureterocele.
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The patient was put in lithotomy position, a 22F cystoscope was introduced into the bladder, the right ureteric orifice was identified and a large left intravesical ureterocele was seen with no apparent left ureteric orifice noticed which goes with the fact that most intravesical ureteroceles have stenotic orifices (Fig. 5, Fig 6), then a 24F resectoscope was inserted, deroofing of the ureterocele with cutting current was performed and the stone was visualized and nudged with the loop into the bladder (Fig. 7, Fig 8, Fig. 9, Fig. 10).
The urinary calculus inside the ureterocele after the deroofing.
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The patient was put in lithotomy position, a 22F cystoscope was introduced into the bladder, the right ureteric orifice was identified and a large left intravesical ureterocele was seen with no apparent left ureteric orifice noticed which goes with the fact that most intravesical ureteroceles have stenotic orifices (Fig. 5, Fig 6), then a 24F resectoscope was inserted, deroofing of the ureterocele with cutting current was performed and the stone was visualized and nudged with the loop into the bladder (Fig. 7, Fig 8, Fig. 9, Fig. 10).
The left ureteric orifice after the deroofing.
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The patient was put in lithotomy position, a 22F cystoscope was introduced into the bladder, the right ureteric orifice was identified and a large left intravesical ureterocele was seen with no apparent left ureteric orifice noticed which goes with the fact that most intravesical ureteroceles have stenotic orifices (Fig. 5, Fig 6), then a 24F resectoscope was inserted, deroofing of the ureterocele with cutting current was performed and the stone was visualized and nudged with the loop into the bladder (Fig. 7, Fig 8, Fig. 9, Fig. 10).
Removal of stone fragments with punch forceps.
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Cystolitholapaxy was performed at the same session and stone fragments were removed (Fig. 11, Fig 12).
The removed stone fragments.
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Cystolitholapaxy was performed at the same session and stone fragments were removed (Fig. 11, Fig 12).
Postoperative day 1 abdominal x-ray.
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The Foley catheter was removed the next day and postoperative abdominal x-ray and urinary tract CT scan without contrast showed no residual stone fragments in the bladder (Fig. 13, Fig 14).
Urinary tract CT scan showing no residual stone fragments.
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The Foley catheter was removed the next day and postoperative abdominal x-ray and urinary tract CT scan without contrast showed no residual stone fragments in the bladder (Fig. 13, Fig 14).
Renal US at 3 months postoperatively.
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Repeat renal and bladder US done at about three months postoperatively showed stable mild left hydronephrosis (Fig. 15, Fig 16).