Flexible ureteroscopy via ureterostomy for managing kidney stones in patients with urinary diversion: a case report

Urinary calculi in patients with urinary diversion, such as bilateral ureterostomies following total cystectomy, present unique challenges due to altered anatomy and physiology. This case highlights the successful use of flexible ureteroscopy via ureterostomy as an alternative approach for managing ureteral stones in this population, adding to the growing body of evidence supporting its feasibility in complex scenarios. A 48-year-old patient presented with sudden-onset right lumbar pain radiating to the external genitalia, consistent with right renal colic, and macroscopic hematuria. Diagnostic imaging revealed a 6 mm obstructing stone in the right kidney associated with ureterohydronephrosis, and laboratory tests showed hyperleukocytosis, elevated C-reactive protein (CRP), and creatinemia. After consultation with the urology team, the patient underwent flexible ureteroscopy through the ureterostomy with in situ laser lithotripsy and placement of a double-J catheter for postoperative drainage. The intervention resulted in complete stone fragmentation, resolution of symptoms, and normalization of renal function. This case underscores the importance of individualized treatment planning and demonstrates that flexible ureteroscopy can serve as a safe and effective minimally invasive alternative to more invasive procedures like percutaneous nephrolithotomy (PCNL) in select patients with altered urinary anatomy.