Pitfalls of the duplex system: the mystery of the missing stone

BMJ Case Rep. 2017 Jun 13:2017:bcr2017220198. doi: 10.1136/bcr-2017-220198.

Abstract

A duplex ureter constitutes about 1% of the renal tract anomalies.A 39-year-old man presented with a 4-week history of left loin pain and microscopic haematuria. Investigation with a non-contrast CT KUB revealed a 6 mm non-obstructing calculus in the left distal ureter.Left ureteroscopy and lithotripsy was planned. However, ureteroscopy failed to identify the calculus. A double J ureteric stent was left in situ and the procedure abandoned in favour of further assessment with a CT urogram. Imaging surprisingly showed a left duplex ureter with the calculus in the non-stented ureter.Repeat ureteroscopy noted the second ureter opening within the distal intramural part of the stented ureter. The calculus was identified and laser lithotripsy performed. A double J stent was appropriately reinserted and removed 2 weeks later.Our case highlights the importance of contrasted imaging prior to performing ureteroscopy for calculus disease.

Keywords: Renal intervention; Urological surgery; Urology.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Hematuria / etiology
  • Humans
  • Male
  • Pain / etiology
  • Stents
  • Tomography, X-Ray Computed
  • Ureter / abnormalities*
  • Ureteral Calculi / complications
  • Ureteral Calculi / diagnosis*
  • Ureteral Calculi / diagnostic imaging
  • Ureteral Calculi / therapy
  • Ureteroscopy