AN UNUSUAL CAUSE OF URETERAL OBSTRUCTION

Abstract

A 74-year-old wheelchair bound man presented with septicemia. Except for extensive co-morbidity from ischemic heart disease, chronic obstructive airway disease and deep vein thrombosis, had a large left, partially reducible inguinoscrotal hernia. After initial management ultrasound examination of the abdomen revealed left hydronephrosis. Antegrade nephrostomy and nephrostogram showed the cause of the obstruction to be a lower ureteral stone with a loop of ureter lying within the hernia (fig. 1). Renal biochemical parameters, which were increased at admission presentation, normalized after the nephrostomy. Despite the stone being successfully treated with extracorporeal shock wave lithotripsy the ureter failed to drain satisfactorily and, thus, a Double-J (Medical Engineering Corp., New York, New York) stent was inserted as the right kidney was not functioning well (fig. 2). Although the stent was not long enough due to the length and tortuosity of the ureter, it effectively relieved the obstruction. For the last 3 years the patient has been kept on 6 monthly stent changes as he is considered unfit for hernia repair.