case_images: PMC8547566_01
case_images: CT reconstruction showing the patient's native kidneys (orange), the right flank transplanted kidney (blue) and the right iliac fossa transplanted kidney (violet)
case_images: 12301_2021_249_Fig1_HTML.jpg
case_images: PMC8547566_01_12301_2021_249_Fig1_HTML.jpg
case_images: Fig1
case_images: One allograft was located in the right iliac fossa (upside-down implantation with ureteric anastomosis following Lich-Gregoir technique, violet in Fig. 1) and the other in the right flank (end-to-side uretero-ureteral anastomosis with native right kidney, blue and orange in Fig. 1).
case_images: Preoperative CT scan shows incomplete staghorn calculi in right iliac fossa transplanted kidney and right native and flank transplanted kidneys dilated by ureteral stone
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case_images: PMC8547566_01_12301_2021_249_Fig2_HTML.jpg
case_images: Fig2
case_images: Non-contrast computed tomography (NCCT) scan showed staghorn calculi in the kidney allograft implanted in the right iliac fossa composed of at least 3 stones of 12.5 mm, 13.7 mm and 10 mm located in superior, medium and inferior calyx, respectively (530 Hounsfield Units) (Fig. 2).
case_images: A Right native (upper kidney) and right flank transplanted kidneys dilated due to ureteral stones impacted in the uretero-ureteral end-to-side anastomosis. B Open-end ureteral catheter ascended after catheterization of the ureteroneocystostomy. Upper pole puncture of the right iliac fossa transplanted kidney under ultrasound guidance. C Antegrade flexible nephroscopy assessing residual fragments after finishing the percutaneous procedure
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case_images: PMC8547566_01_12301_2021_249_Fig3_HTML.jpg
case_images: Fig3
case_images: Endovision puncture was not attempted in order to protect the reusable flexible ureteroscope from an extreme proximal ureteral kinking loop (Fig. 3B). After most of the stone fragments had been removed, antegrade flexible nephroscopy (Flexible Fiber-Cystoscope 15Fr, Richard Wolf, Germany ) was conducted to search for residual stones in locations that were inaccessible with the rigid nephroscope (Fig. 3C).
case_images: Postoperative CT scan without neither residual fragments nor subcapsular hematoma
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case_images: PMC8547566_01_12301_2021_249_Fig4_HTML.jpg
case_images: Fig4
case_images: Postoperative NCCT scan, performed 12 h postoperatively, showed neither residual fragments nor suggestive signs of immediate postoperative complications (Fig. 4).