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case_images: Computed tomography scan of the patient.
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case_images: Further examination revealed normal serum creatinine (1.3 mg/dL) with bilateral hydronephrosis and renal stone (Fig. 1).
case_images: Retrograde pyelogram of the patient.
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case_images: However, during the left ureteroscopy, severe UPJO was found (Fig. 2), thus the procedure was stopped, and the patient was referred.
case_images: Laparoscopic ureterocalicostomy and lithotripsy under direct vision from laparoscopic scope. DJ = double-J stent; FP = fibrotic pyelum; IC = inferior calyx; SL = ShockPulse lithotripter; ST = stone; U = ureter.
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case_images: However, during the pyeloplasty, after identifying the ureter and inferior calyx (Fig. 3A), there was severe fibrosis and adhesion surrounding the left ureteropelvic junction (UPJ) along with high ureteral insertion (Fig. 3B). An incision was made at the inferior calyx, and bleeding was controlled with bipolar cautery (Fig. 3C-E). Hence, a lithotripsy was performed using the Olympus ShockPulse-SE Lithotripter, which was guided under direct vision of the laparoscopic scope (Fig. 3F). After all visible stones were removed, ureterocalicostomy was completed (Fig. 3G-I) and the procedure was finished by leaving left nephrostomy tube, left double-J ureteral stent and drain.
case_images: Ultrasound of the patient after 2 months.
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case_images: Evaluation was performed two months later, revealing a significant improvement in left hydronephrosis with no residual stone (Fig. 4).
case_images: Retrograde pyelogram after 3 months.
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case_images: A retrograde pyelogram was performed three months after the procedure showing good anastomosis with no stenosis or leakage (Fig. 5).