Ureteroceles are rare congenital abnormalities of the distal ureter that can coexist with ureteric calculi and may present with vague flank pain or remain asymptomatic for years. When they co-occur with obstructive stones, particularly near the ureterovesical junction (UVJ), precise imaging and expert surgical management are essential. This case illustrates the clinical journey of a 50-year-old male who was successfully treated at the Institute of Urology, Jaipur for a left UVJ calculus with bilateral ureterocele—showcasing our expertise in complex endourological procedures and stone management.
Case Presentation
A 50-year-old male, a known case of hypertension on regular medication, presented to our outpatient department with on and off right-sided flank pain for the last few weeks. He reported no urinary complaints, no hematuria, fever, or lower urinary tract symptoms.
Initial Investigations
Given the flank pain, a USG whole abdomen was performed as the first line of investigation. The scan revealed:
- Grade I hydronephrosis in the left kidney
- A dilated left ureter with a 4 mm UVJ calculus
- Presence of cystic dilatation at bilateral UVJ regions, suggestive of bilateral ureterocele
To confirm and assess further anatomical detail, a CT Urography was advised. It confirmed:
- The presence of left UVJ calculus
- Bilateral ureterocele
- Mild thickening of the urinary bladder wall, necessitating further endoscopic evaluation
Clinical Plan and Management
After reviewing the findings and thorough discussion with the patient and his family, the following plan was agreed upon:
- Diagnostic cystoscopy to visually assess the bladder wall and ureteric orifices
- Incision of the left ureterocele
- Left-sided ureteroscopy (URS) for the removal of the 4 mm UVJ stone
- Placement of a Double J (DJ) stent for postoperative drainage and healing
This plan was executed on Day 1 of admission. The ureterocele was successfully incised with no bleeding or complications. The URS was smooth, and the 4 mm stone was removed completely. A DJ stent was placed, and the patient remained stable throughout the procedure.
Postoperative Course
The patient was discharged the very next day in a stable condition, with detailed instructions regarding postoperative care, hydration, and activity. He was advised to return in 5–6 weeks for DJ stent removal.
Follow-Up
At his postoperative follow-up, the patient reported being completely pain-free and back to his normal routine.
Discussion
Ureteroceles can complicate stone disease by contributing to obstruction and recurrent infections. Endoscopic incision is a minimally invasive, effective treatment. In this case, combining ureterocele management with ureteroscopy in a single sitting ensured complete resolution of symptoms and eliminated the need for repeat interventions.
Our decision to proceed with CT urography before surgery showcases our philosophy: only necessary investigations are done, but no critical diagnostic step is missed. This careful balance ensures quality over quantity in patient management.
Institutional Excellence
At the Institute of Urology, Jaipur, we are proud to deliver world-class care in urology and general surgery, backed by:
- A legacy of over 30 years in advanced urological treatments
- The immense experience and clinical acumen of Dr. M. Roychowdhury and Dr. Rajan Bansal, known across Rajasthan and India for their surgical precision and patient-centered care
- Latest-generation endoscopic and laser equipment, enabling us to treat even the most complex cases without open surgery
- A strong reputation for close to 100% stone clearance rates in urological stone disease
- Fully integrated infrastructure, where consultations, diagnostics, advanced surgeries, and postoperative care are all conducted under one roof, offering patients a seamless and hassle-free experience
Conclusion
This case is a perfect example of how expert clinical judgment, targeted diagnostics, and advanced minimally invasive surgery can lead to excellent patient outcomes in cases involving stone disease with congenital anomalies like ureterocele. The Institute of Urology, Jaipur, continues to stand out as a leading destination for urological excellence, where every patient is treated with precision, compassion, and complete transparency.
