Acute Obstructive Uropathy with AKI in a young patient managed precisely by Institute of Urology, Jaipur: Acute obstructive uropathy with anuria is a urological emergency, especially in young patients. Early diagnosis, rapid metabolic stabilization, and immediate relief of obstruction are essential to prevent irreversible renal damage. This case demonstrates the successful management of a rare, severe presentation of bilateral distal ureteric obstruction (bilateral VUJ stones) causing acute kidney injury, treated efficiently at the Institute of Urology, Jaipur—a centre known across Rajasthan and North India for excellence in endourology and minimally invasive urological procedures.
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Patient Profile and Presentation
A 23-year-old male presented to the emergency department with:
- Bilateral flank pain for 3 days
- Anuria (no urine output) for 72 hours
- No fever, chills, or signs of sepsis
- No prior significant medical history
This presentation indicated a high-risk acute renal emergency.
Clinical Examination
- Patient alert, hemodynamically stable
- Mild abdominal fullness
- No peritonitis
- No respiratory distress
- No peripheral edema
Given the anuria and severe flank pain, immediate investigations were initiated.
Laboratory Investigations
| Parameter | Value | Interpretation |
|---|---|---|
| Serum Creatinine | 8.36 mg/dL | Severe renal impairment |
| Serum Potassium | 5.55 mEq/L | Mild hyperkalemia |
| ECG | WNL | No hyperkalemic changes |
| CXR | NAD | No acute cardiopulmonary abnormality |
The biochemical profile confirmed acute kidney injury secondary to obstruction.
Radiological Investigations
Ultrasonography (USG KUB)
- Mildly bright bilateral kidneys
- Bilateral hydroureteronephrosis
- Suspicion of obstructive uropathy
- Minimal ascites
- Bilateral minimal pleural effusion
These findings suggested early systemic fluid shift secondary to renal obstruction.
Non-Contrast CT KUB (NCCT)
NCCT revealed:
- Bilateral hydroureteronephrosis
- Bilateral VUJ calculi – source of obstruction
- Small non-obstructive renal calculus on left
- Enlarged, globular, hypoattenuating kidneys, consistent with acute obstructive uropathy
- Mild ascites
- Bilateral minimal pleural effusion
This imaging confirmed complete lower ureteric obstruction on both sides, explaining the patient’s anuria and rising creatinine.
Diagnosis
Acute Bilateral Obstructive Uropathy due to Bilateral VUJ Calculi, resulting in severe AKI (creatinine 8.36 mg/dL) with mild systemic effects (ascites, pleural effusion).
Management Approach
Clinical Decision-Making
Given the extremely critical nature of complete bilateral obstruction in a young patient, the case required – to the point, accurate diagnosis, rapid planning, and immediate intervention.
The patient and family were thoroughly counselled about the severity of the condition and the urgent need for operative decompression.
At the Institute of Urology, Jaipur, we emphasize that precise diagnosis is the backbone of definitive treatment planning.
Our multi-modal approach—combining imaging, metabolic assessment, and surgical expertise—ensures that no detail is missed.
Surgical Intervention: Bilateral URS with DJ Stenting
The patient underwent:
✔ Bilateral Ureteroscopy (URS)
✔ Bilateral DJ stent placement
Intraoperative Highlights
- Stones were identified at both VUJ locations.
- They were fragmented and cleared using advanced laser technology.
- DJ stents were placed bilaterally to ensure unobstructed drainage.
- Minimal bleeding and no intraoperative complications.
- Procedure performed in a single session.
The surgery was carried out by:
🔹 Dr. Rajan Bansal
Renowned for his exceptional skill in endourology, laser stone management, and minimally invasive urology.
His precision and calm handling of complex bilateral cases set an unmatched benchmark in Rajasthan.
🔹 Dr. M. Roychowdhury
Known for his sharp clinical judgement and flawless decision-making in critical emergencies.
His ability to strategize the safest and most effective treatment path is widely respected across India.
The combination of their expertise allowed safe restoration of urinary drainage in a high-risk scenario.
Postoperative Course
- Urine output resumed immediately after surgery.
- No hematuria, infection, or complications.
- Creatinine started improving steadily.
Follow-Up
At the follow-up visit after a few weeks:
- Serum creatinine improved to 1.9 mg/dL
- No residual flank pain
- No recurrence of symptoms
- Ultrasound confirmed resolving hydronephrosis
- Patient had completely returned to normal daily activities
The patient and family expressed deep satisfaction with their care, reflected in their dramatic improvement, praising the prompt diagnosis, swift management, and excellent surgical outcomes.
Discussion
Bilateral distal ureteric calculi causing complete obstruction in a young male is uncommon but can rapidly progress to life-threatening renal failure. Immediate intervention is crucial to prevent permanent nephron loss.
This case demonstrates:
- Importance of accurate early imaging (USG + NCCT)
- Need for timely decompression
- Value of high-volume expertise in URS/RIRS
- Role of advanced endoscopic technology
- Superiority of a center with integrated diagnostic-to-intervention capability
The Institute of Urology, Jaipur is one of Rajasthan’s leading urological centers, consistently upgrading to world-class standards with:
- Cutting-edge laser systems
- High-resolution endoscopes
- Modular operation theaters
- Rapid diagnostic pathways
- Experienced surgeons
- Excellent patient satisfaction scores
Conclusion
This case highlights the successful management of acute bilateral obstructive uropathy in a young adult using a precision-based, minimally invasive approach. The expertise of Dr. Rajan Bansal in endourology and the unmatched clinical vision of Dr. M. Roychowdhury, combined with the state-of-the-art infrastructure at the Institute of Urology, Jaipur, enabled a full functional recovery in a potentially life-threatening situation.
Our hospital remains committed to delivering world-class, evidence-based, technologically advanced, and patient-centered urological care, leaving no stone unturned—both literally and metaphorically.
