PMC9019460_01
Abdominal CT scan showed the following: (a) coronal view shows both functioning (red arrow) and dilated ureter with proximal dilatation (yellow arrow); (b) 3D CT construction showing midureteric stone (yellow arrow), nonobstructed ureter with complete urinary drainage from upper segment (red arrow), and hydronephrotic segment (blue arrow); (c) contrast film showing lower pole nonfunctioning and hydronephrotic kidney.
CRIU2022-6552889.001.jpg
PMC9019460_01_CRIU2022-6552889.001.jpg
fig1
The left kidney duplex pelvis with two complete ureters draining into the bladder where the lower kidney draining ureter was dilated to the level of the fourth lumbar vertebrae with obstructed stone measuring 7 mm in diameter (Figure 1).
(a) Preoperative cystoscopy showing the two left ureteric orifices where the medial is allowing JJ stent placement (yellow arrow) and the lateral one is intubated with a ureteric catheter (red arrow) (obstructed ureter). (b) KUB shows the two catheters where the lateral could not go beyond the mid sacrum because of ureteric stone (yellow arrow) and normally placed (red arrow) JJ stent.
CRIU2022-6552889.002.jpg
PMC9019460_01_CRIU2022-6552889.002.jpg
fig2
The obstructed ureteral orifice appears lateral and caudal where the ureteric catheter advanced till to the obstructed part (midureter) due to impacted stone with no association with ureterocele (Figure 2).
Intraoperative imaging. (a) Dilated proximal ureter draining lower moiety (yellow arrow), another ureter draining upper moiety (black arrow). (b) Hydronephrotic segment (red arrow). (c) Repair of the upper segment after lower pole resection (blue arrow).
CRIU2022-6552889.003.jpg
PMC9019460_01_CRIU2022-6552889.003.jpg
fig3
The two ureters were identified and found with the upper pole insertion, and the other was draining the lower pole (Figure 3(a)). The lower segment vasculature and upper moiety blood supply were identified, and the left partial nephrectomy was done (Figures 3(b) and 3(c).