40-year-old man with a mid-ureteral stone underwent an attempted ureteroscopic lithotripsy (TUL) at an outside institution. Initial ureteroscopic access failed because a tight ureteral narrowing/stricture precluded advancement of the ureteroscope, and the procedure was aborted. A double-J ureteral stent was placed and the patient was discharged.
He re-presented the following day with flank pain. Subsequent imaging demonstrated ureteral injury consistent with perforation, with urinary extravasation and urinoma formation. A percutaneous nephrostomy (PCN) was inserted for urinary diversion.
On follow-up CT, the urinoma persisted, and the double-J stent was found to be malpositioned. The patient was then referred to our center for further management.
At our institution, a ureteral catheter was placed and retrograde pyelography was performed; antegrade nephrostography was also obtained. Retrograde pyelography confirmed ureteral perforation with contrast extravasation. Nephrostography revealed that the nephrostomy catheter was not within the collecting system; instead, it had inadvertently been positioned within the urinoma cavity without access to the pelvicalyceal system, explaining the
inadequate diversion and persistent urinoma.
reteroscopy was subsequently attempted; however, a high-grade ureteral narrowing again precluded passage. A hydrophilic guidewire was used to traverse the narrowed segment, after which an appropriately positioned double-J
ureteral stent was successfully deployed to bridge the injured segment and re-establish internal drainage.
Post-procedure, the patient showed rapid clinical improvement. Follow-up imaging confirmed a significant reduction of the urinoma, and he was subsequently discharged in stable condition.