PMC5628567_01
Images from noncontrast CT kidney, ureter, and bladder. Arrow points to (a) dilated right ureter. Contrast given at the time of the CTPA (done previously) is seen to pool in the dilated ureter; (b) dilated right renal pelvis; (c) dilated right ureter; (d) stricture in distal right ureter.
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CT of the kidneys, ureter, and bladder revealed a dilated and hydronephrotic right pelvicaliceal system with a dilated right ureter traceable to the distal ureter. Contrast administered at the time of the prior CTPA could still be seen in the dilated right ureter (Fig. 1).
Fluoroscopy images from initial attempt at ureteroscopy and retrograde Double-J stent insertion. Arrows point to (a) extravasation of contrast during retrograde study, probably caused by a ureteral perforation from the guidewire, (b) sensor guidewire kinking at level of distal ureteral stricture, (c) guidewire manipulated into appropriate position within the ureter, (d) Double-J ureteral stent placed effectively with coil in upper pole, and (e) coil in bladder.
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Retrograde studies at this point showed extravasation indicating ureteral perforation (Fig. 2).
Ureteral biopsy. Arrows point to (a) egg of Schistosoma, (b) giant cell, and (c) eosinophil.
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Sequential MAG-3 renograms. (a) soon after third look ureteroscopy with no stent in place:equivocal drainage from right kidney, (b) 3 weeks later with no stent:obstructed right kidney, (c) after stent was reinserted:unobstructed, and (d) after Boari flap ureteral reimplant with no stent:unobstructed.
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Follow-up MAG-3 showed normal unobstructed drainage (Fig. 4).