PMC6340373_01
Plain KUB showed forgotten Double-J with the stone formation at both sides of the coils. KUB, kidney, ureter, and bladder radiograph.
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(a) Cystoscopic view showing the broken piece of the Double-J and encrustation; (b) ureteroscopic view of the Double-J showing extensive encrustation and stone formation.
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The calculus along the broken distal coil of Double-J (Fig. 3a) was cleared with a lithoclast and distal coil (which had been broken and separated from the other part of the Double-J stent) removed alone. The ureteroscopy (URS) was done and stones with encrustations (Fig. 3b) along the Double-J were cleared using both the holmium laser (Calculase II; Karl Storz, Tuttlingen Germany) and lithoclast (Nidhi Meditech System, Ahmedabad, India) until the proximal coil inside the renal pelvis and the entire remaining part of the Double-J was removed (which was confirmed by a C-arm).
Two tract mini-PCNL and flexible nephroscope for clearance of the stones. PCNL, percutaneous nephrolithotomy.
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At the same session, the renal pelvis stone and the lower and mid calix stones were cleared by a two-tract mini-PCNL (20F Amplatz sheath) in a prone position; the intraoperative clearance was checked by a C-arm and flexible nephroscope (Fig. 4).
Removed Double-J stent showed a broken piece and the rest of Double-J with encrustation, with fragmented stones remove by PCNL.
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Postoperative KUB showed new inserted Double-J and stone-free status.
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PCNL. Postoperative plain KUB demonstrated the new Double-J stent with no stone fragments (Fig. 6).