Distal Ureteral Calculus or Deflux Calcification?

Abstract

Background: There have been >50,000 dextranomer-hyaluronic acid implants performed since 2001, and each has the potential to calcify. Although they are most often asymptomatic, these calcifications may mimic large distal ureteral calculi and are often misidentified on CT performed for suspected urolithiasis or other complaints. Case Presentation: We report the case of a 21-year-old woman who presented with symptoms consistent with obstructive uropathy who was reported to have bilateral ureteral-vesicular junction calculi on abdominal CT evaluation. On further questioning she relayed the history of a vague urologic procedure as a child but was unable to characterize it further. On the basis of her relatively mild symptoms, urinalysis and renal ultrasonography were obtained demonstrating bilateral ureteral jets and she was diagnosed with nonobstructing bilateral dextranomer-hyaluronic acid calcifications and a presumed urinary tract infection that resolved with empiric antibiotic therapy. Conclusion: Accurate diagnosis of implant calcification is critical to effective therapy and avoiding unnecessary radiation or anesthesia. This diagnosis should be suspected with radiologically demonstrated large ureteral calculi but relatively mild presenting symptoms. As dextranomer-hyaluronic acid implantation is routinely performed in young patients it is also possible that this relevant history will not be reported.