Friday, July 09, 2010

Bilateral urinary calculi- an unusual case

This was a rather unusual case. This elderly male patient complained of pain in the flanks. He was suspected to have lower urinary tract obstruction (meaning a prostate enlargement). Ultrasound imaging of the kidneys (above) show bilateral moderate hydronephrosis, with more severe changes in the left kidney (right half of image). The image shows a large calculus of 2.3 cms. lodged in the left pelvi-ureteric junction (uretero-pelvic junction). But what is the cause of the right hydronephrosis?

The cause of the right hydronephrosis is now obvious- 2 calculi are seen at the right vesico-ureteric junction.

TRUS (transrectal ultrasound) examination confirms the findings. Arrows show 2 calculi in the distal most part of the right ureter (in the vesico-ureteric junction).

Despite the urinary bladder being nearly empty, the right vesico-ureteric junction calculi are seen on TRUS image (only one of the 2 calculi see in this image). The prostate itself only showed mild hypertrophy. This is the first case I stumbled upon with a VUJ (vesico-ureteric junction) and UPJ (uretero-pelvic junction) calculi in the same patient.
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