Staged bilateral endourological treatment for urolithiasis in situs inversus totalis: a case report

Abstract Background Situs inversus totalis is a rare congenital anatomical variation characterized by the mirror-image transposition of thoracic and abdominal organs. This variation increases the risk of organ malformations, such as ectopic kidneys, and poses unique technical challenges for endoscopic procedures like retrograde ureteroscopy. This case demonstrates that a staged surgical approach can safely and effectively treat complex bilateral renal stones in situs inversus totalis, despite concurrent urosepsis and poorly controlled diabetes. Case presentation A 72-year-old female presented with bilateral flank pain accompanied by fever, with no family history of situs inversus totalis. Computed tomography(CT) revealed dextrocardia, complete abdominal organ transposition, and bilateral multiple renal stones (estimated maximum volume was 579 mm³ on the left side and 467 mm³ on the right side). Due to concomitant urosepsis and poorly controlled diabetes, a staged surgical approach was adopted: emergency bilateral ureteral stent placement for decompression, followed by bilateral retrograde ureteroscopy and stone fragmentation in the second stage after infection control. Results The patient had no residual stones on postoperative X-ray, and bilateral stents were successfully removed at three months postoperatively. Conclusion The presence of complications associated with kidney stones increases the surgical difficulty of retrograde ureteroscopy. In complex cases where complete situs inversus is also present, a staged surgical strategy is crucial for ensuring patient safety and surgical success.