Shockpulse lithotripsy during laparoscopic ureterocalicostomy for renal stone concomitant with secondary ureteropelvic junction obstruction: A case report

Introduction: In adult patients, most ureteropelvic junction obstruction (UPJO) occurs secondarily. Concurrent UPJO with nephrolithiasis is not rare and simultaneous treatment by performing laparoscopic pyeloplasty and endoscopic stone removal has been suggested. In the case of atypical anatomy or previously failed pyeloplasty, a laparoscopic ureterocalicostomy is preferred. This study presents a case where a severe UPJO coexistence with renal stone was treated with laparoscopic ureterocalicostomy and direct lithotripsy using ShockPulse lithotripter through the laparoscopic port.

Presentation of case: A 24-year-old male with a history of bilateral open pyelolithotomy came with left flank pain. Further examination revealed a left UPJO and multiple nephrolithiasis. During laparoscopic pyeloplasty, significant adhesion and fibrosis were encountered around the ureteropelvic junction, rendered it challenging to perform pyeloplasty. Consequently, left ureterocalicostomy and direct lithotripsy using ShockPulse lithotripter through the laparoscopic working port were performed. After 3 months, the double-J stent was removed with no complication.

Discussion: The typical minimal invasive options for stone removal for UPJO with large or multiple nephrolithiasis are through percutaneous nephrolithotripsy (PCNL) or direct stone removal during laparoscopy. However, by using the ShockPulse lithotripter, large or multiple calculi can be easily fragmented and siphoned through the laparoscopic port. This technique might help to shorten the operative time and reduce the risk of migrating stone to the abdominal cavity after opening the inferior calyx.

Conclusion: Simultaneous lithotripsy using ShockPulse lithotripter during laparoscopic ureterocalicostomy is a safe and feasible option in treating complex UPJO concurrent with renal stone.