A 67-year-old male patient underwent a ureteroscopic stone surgery to remove multiple ureteral stones in the left one 1 year ago in a local clinic. The patient could not endure the DJ catheter-related discomfort and the physician removed the DJ catheter after a day after the operation.

The patient did not visit the hospital for a year. Then, he visited the ER of SMG-BRM Boramae Medical Center and we detected newly appeared ureteral stones. However, we could not remove the stones because there was no opening of the ureterovesical junction on the left side, and this meant the presence of the left ureterovesical junction obstruction.

Antegrade approach vs open surgery

First, I tried to perform AIRS (antegrade intrarenal surgery) or PASS (percutaneous antegrade stricture surgery).

Total stricture segment: 5 cm ( an upper stricture segment of 1.5cm, a ureter lumen with small stones of 1.5cm, a lower stricture segment and stones of 2cm)

I finally performed the psoas hitch procedure.

Take home messages: (1) URS should be carefully performed to avoid ureter stricture. (2) The AIRS or PASS should be performed in the short stricture segment < 2cm. (3) Small talks about the duration of the DJ catheter indwelling, etc.