Upward migration of DJ stent associated with proximal ureteral stones is a rare situation. A 41-year-old man who had upward migrated DJ stent and proximal ureteral stones is presented. Upward migrated DJ stent was removed by ureteroscopy and proximal ureteral stones were successfully fragmented by pneumatic lithotriptor. Upward migrated DJ stent can be removed and proximal ureteral stones can be treated with minimally invasive endoscopic surgery at the same session. Introduction Upward migration of DJ stent is occasionally encontered in urologic practice[1]. Ureteroscopy is usually used to remove upwarted DJ stent[2,3]. However, DJ stent can be complicated by encrustation, stone formation. The management of these complications remains a challenging task. Generally, a combined approach of percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy (SWL) with ureteroscopy, intracorporeal lithotripsy can be used to remove them. If the endourologic procedure fails, open surgery should be used to extract the stents[1,4,5]. Herein, the author report the use of minimal invasive treatment in a patient who had upward migrated DJ stent and proximal ureteral stones. Case report A 41-year-old man presented with right flank pain, haematuria, dysuria and pollacuria. Before referred to our hospital, DJ stent had been placed to drain the right kidney one month ago and SWL had been performed on the right side proximal ureteral stones twice. Physical examinaton revealed slight tendernes on the right flank region. Laboratuary studies including blood count, blood chemistery were normal. Urine samples showed microscopic haematuria and pyuria; however, urine culture yielded no significant colonization. Proximal ureteral stones had been diagnosed at plain abdominal x-ray on the right-sided urinary system and ?ntravenous urography(IVU) also had revealed grade IV hydronephrosis on the same side before SWL and DJ stent placement (Fig.1A,B). Upward migrated DJ stent was determined on plain abdominal x-ray on the right-sided urinary system(Fig.1C). Ureteroscopic management was planned. Under general anaesthesia, 8/9.8 Fr Wolf semirigid ureteroscope was inserted into bladder. A 5 f ureteral catheter was placed prior to insersion of the ureteroscope. After insersion of the ureteroscope the ureteral catheter was removed. Upward migrated DJ stent was removed by the grasping forceps successfully. After identification the stone, pneumatic lithotripsy was performed and successfull fragmentation was achieved without any complications. A new 5F DJ stent was inserted. The operative time was less than 45 minutes. Successfull fragmentation was demonstrated on post-operative first day plain abdominal x-ray (Fig.1D).
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