A 73-year-old female patient was referred to the Urology Department complaining of right lumbar pain and microhematuria for 1 month.
His personal history included hysterectomy for fibroids 26 years ago and left inguinal hernia 15 years ago.
It was diagnosed in 1998 as multiple myeloma Ig G Lambda stage IA (quiescent), following periodical revisions in a typology service without following any treatment.
Hypertension and hyperglycaemia in dietary treatment.
Background: Raynauds phenomenon under rheumatology follow-up.
No medical treatments today.
When the patient is totally asymptomatic, she develops right lumbar pain without clear irradiation or other accompanying symptoms.
Physical examination revealed a mildly positive right renal percussion.
The urine element and sediment showed the presence of 60-80 parasites per field, the urine culture was negative and the urine cytology was also negative for malignant cells.
The ultrasound study showed completely normal kidneys and bladder and intravenous urography showed kidneys of normal size, morphology and function, with a permeable excretory pathway.
At 3 weeks the patient returns for exacerbation of right lumbar pain and emission of thin and elongated clots.
A new urine cytological study was performed, which was also negative and a new urography showed grade II hydronephrosis secondary to right distal ureter stenosis.
Right retrograde pyelography confirmed the presence of a distal stenosis of 2-3 cm.
Washing samples were taken from this ureter for cytological study that were negative for malignancy.
Antimicrobial treatment was prescribed, resulting in mild clinical improvement, which worsened again after 2 months. At this time, the patient presented bilateral low back pain radiating to flanks and the elimination of clots persisted.
A new urographic study was carried out which this time demonstrated the presence of bilateral grade III hydronephrosis secondary to distal stenosis of both ureters.
T.A.C. abdominopelvic was performed which ruled out the existence of extrinsic processes that cause the stenosis, only showing a punctate ureteral lumen occupied in both ureters.
Careful cystoscopy was performed which was normal and wash samples were taken from both ureters, with a very diffi cult catheterization, resulting in a negative cytological study.
Due to the evolution and bilaterality of the condition, it was decided to perform an open surgery, finding a normal ureter macroscopically, without being encompassed in fibrous or adhesional processes, requiring an intraoperative biopsy of the stenotic segment.
Polytane-Leadbetter bilateral cystotomy was performed.
The definitive anatomopathological study confirmed the presence of chronic inflammation, edema and fibrosis of the lumen of both ureters affecting mainly the submucosa, without evidence of granulomas, vasculitis or amyloid deposits.
At 3 months of follow-up the patient was asymptomatic and the urographic study showed normal kidneys, with permeable ureters until entering the bladder ; at 6 months the patient remains asymptomatic.
