PMC9172089_01
NCCT KUB Scan showing bilateral large upper ureteric calculi with gross hydroureteronephrosis and cortical thinning
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Fig1
Noncontrast computerized tomography (NCCT) scan of abdomen revealed bilateral large proximal ureteric calculi (right calculus measuring 2 cm with a radio-density of 1102 HU and left calculus measuring 2.96 cm with a radio-density of 604 HU) causing bilateral gross grade-IV hydroureteronephrosis and severe cortical thinning (Fig. 1).
X-ray KUB showing bilateral ureteric calculi with bilateral percutaneous nephrostomy
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Fig2
He underwent bilateral percutaneous nephrostomy (PCN), by interventional radiologist under both USG and fluoroscopy guidance (Fig. 2).
a Modified right lateral decubitus position with 3 midline ports for trans-peritoneal laparoscopic left ureterolithotomy. b Modified left lateral decubitus position with 2 midline ports and drain through the suprapubic port after completion of trans-peritoneal laparoscopic right ureterolithotomy. c Left and right ureteric calculi seen intraoperatively, respectively. d Right and left ureteric calculi after laparoscopic extraction
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Fig3
Initially, patient was placed under modified right lateral decubitus position and pneumoperitoneum was created through Veress needle technique; 3 ports were placed : one 10-mm camera port just above the umbilicus, one 10-mm working port in the midline suprapubic region and one 5-mm working port in the midline epigastric region (Fig. 3a). Both the left and right ureteric calculi were removed through the 10-mm suprapubic port, and a tube drain was placed through the same port site (Fig. 3b, c, and d).
Satisfactory position of bilateral DJ stents on X-ray KUB on first postoperative day
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Fig4
DJ stents (Fig. 4). Drain was removed on second POD, and he was discharged after removal of per-urethral catheter on third POD.
Postoperative NCCT KUB scan after removal of DJ stents, showing improvement of bilateral hydronephrosis
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Fig5
NCCT scan, done 2 months postoperatively, showed improvement of bilateral hydronephrosis to grade-III (Fig. 5).