Concomitant management of bilateral obstructive uropathy: A case report

A 13 years old female patient presented in our emergency department with chief complains of on & off fever for since 1 week and pain in right lumber region and vomiting for 1 day. Patient had also complain of difficulty in miturition. Initially abdominal ultrasound was done which is suggestive of approx. 18x12 cm2 sized multiloculated cystic lesion in right kidney with internal echoes with marked thinning of renal parenchyma p/o pyonephrosis and 19mm calculus in left renal pelvis and 9mm & 5 mm calculi in lower calyx. Initial investigation suggest altered renal function test with uremia. Initially, percutaneous nephrostomy was done on right side to relieve obstruction. After normalizing renal function, ct-kub done which is suggestive of large collection with surrounding fat stranding at right pelvi-ureteric junction with no passage of contrast in right ureter and there was partially obstructing renal calculus in left kidney. Then, patient undergone left pyelolithoyomy. After few days, nephrostomogram was done through right nephrostomy tube which is suggestive of complete PUJ stricture. So, right side pyeloplasty was done. Patient was discharged satisfactorily with removal of both D-J stents few weeks later.