Simultaneous bilateral multipuncture tubeless percutaneous nephrolithotomy in patient with orthotopic bladder substitution.

We report the successful treatment of a patient that presented with bladder tumor, bilateral multiple renal stones, right lower ureteral stone, and bilateral hydroureteronephrosis with progressively rising serum creatinine. Initially, he was managed by drainage of the upper tract by left percutaneous nephrostomy tube until serum creatinine dropped to normal value then he was managed by radical cystectomy and orthotopic bladder substitution. Three weeks later, he was subjected to simultaneous bilateral multi-puncture tubeless percutaneous nephrolithotomy. In addition, we report on the feasibility of opacification of the collecting system via ascending pouchogram by direct passage of the dye through the directly implanted ureters thus avoiding intravenous contrast injection.