PMC6225075_01
CT scan image indicates a bullet fragment in the right UPJ (a, transverse view; b, sagittal view). UPJ = ureteropelvic junction.
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The CT scan revealed hydronephrosis of the left kidney and a 15 mm calcification in the left UPJ and an atrophic right kidney (Fig. 1a, b).
Fluoroscopic image of bullet fragment noted in the right UPJ with Double-J ureteral stent noted in place.
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Upon planning the elective procedure, review of the films with radiologist in context of the patient's prior history of a left gunshot wound indicated the high possibility that the calcification in the left UPJ was actually the bullet possibly surrounded by stone formation (Fig. 2).
Bullet fragment specimens postextraction.
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Due to the inability of the laser to fragment the metal, the gun shell shard was grasped, pulled into the sheath, and the sheath and fragment were removed together (Fig. 3).