Comprehensive surgical strategy for incarcerated ureteral calculi in the context of double renal pelvis malformations: A case report.

INTRODUCTION AND

IMPORTANCE

Managing incarcerated ureteral calculi is crucial to prevent obstructive uropathy, renal dysfunction, and urosepsis. Double ureteral malformations with complex calculi pose challenges due to anatomical variations, requiring a multidisciplinary approach.

CASE PRESENTATION: A 35-year-old female with flank pain and hydronephrosis was diagnosed with double renal pelvis malformations and impacted ureteral calculi. A staged approach was used: laparoscopy corrected ureteral malformations, followed by flexible ureteroscopy and percutaneous nephroscopic holmium laser lithotripsy. Complete calculus clearance was confirmed intraoperatively and postoperatively.

CLINICAL DISCUSSION: Double ureteral malformations complicate endoscopic navigation, requiring combined laparoscopic correction and lithotripsy. Challenges included limited space and risk of iatrogenic injury. Holmium laser (0.8-1.2 J) enabled precise fragmentation while preserving mucosa. Preoperative 3D CT urography was vital for surgical planning.

CONCLUSION

At 6-month follow-up, the patient had patent ureteral drainage, no calculus recurrence, and stable renal function. Integrated laparoscopy-endoscopy strategies achieved a 100 % calculus-free rate with minimal complications, emphasizing the importance of image-guided, patient-specific management in complex urolithiasis.