case_images: PMC9562977_01
case_images: Portal phase of the computed tomography (CT) of the abdomen and pelvis with IV contrast injection showing a proximal ureteral and calyceal dilatation, a lower calyceal stone and a tapering of the right ureter (arrows). (A) Coronal view. (B) Axial view.
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case_images: The patient had continuous unrelenting right flank pain with a subsequent abdominopelvic ultrasound and CT scan showing the evidence of a residual 17 mm by 26 mm staghorn calculus with an average density of 470 HU residing in the inferior calyceal system, associated with a proximal ureteral and calyceal dilatation (Figure 1), nevertheless without any evidence of ureteral stone or stenosis.
case_images: X-ray fluoroscopique image (A) and schema (B) of the stenotic ureter.
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case_images: The length of the non-opacified zone and therefore of the stenosis was estimated to be of 2 cm (Figure 2).
case_images: The stenotic lesion as seen by the antegrade flexible ureteroscope.
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case_images: Using a disposable flexible ureteroscope for antegrade ureteroscopy, a pinhole lesion was observed and was considered as the stenotic lesion (Figure 3).
case_images: Ho: YAG laser incision of the stenotic lesion using the antegrade ureteroscope.
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case_images: With the aid of a 365-microm Ho: YAG laser (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion (Figure 4).
case_images: Guidewire was passed from antegrade ureteroscopy (A and B). Illumination of the obstruction by the retrograde approach (C).
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case_images: A Terumo guidewire was then passed through this incision down to the bladder and retrieved through the urethral orifice as a through-and-through guidewire as such securing the ureter (Figure 5A and B). At this time, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope (Figure 5C).
case_images: Stenotic area post laser endoureterotomy and ureteral dilatation.
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case_images: In order to insert a retrograde 10/12 Fr ureteral access sheath, we dilated the ureter progressively with ureteral catheters of 7, 8 and 9 Fr and then we progressed with a full thickness incision beside the guidewire and under observation by the retrograde ureteroscope to ensure an efficient incision (Figure 6).