Antegrade left ureterolithotripsy in a patient with previous psoas-hitch ureteral reimplantation

Abstract

A standard surgical treatment of distal ureteric defects is represented by the ureteroneocystostomy-ureteric reimplantation. However, the procedure involves an anatomical alteration of the ureterovesical (neo)junction that often hinders the retrograde catheterisation of the reimplanted ureter.We describe a case of antegrade ureterolithotripsy (AULT) in a psoas-hitch reimplanted ureter. A woman with severe left hydronephrosis supported by a subcentimetric proximal ureteral stone in a psoas-hitch reimplanted ureter was referred to our unit. Retrograde ureteroscopy was unsuccessful due to impossibility in incannulating the ureteral neo-orifice. Following the placement of a percutaneous nephrostomy, percutaneous AULT through ureteral sheath was successfully performed with complete treatment of the stone.AULT may represent a viable alternative in the management of ureteral stones when the upper urinary tract is not amenable to retrograde ureteroscopy. In experienced hands, the procedure is straightforward and may avoid the adoption of transabdominal approaches.