Surgical management of incomplete duplex kidney with calculus and homolateral ureterovesical junction obstruction: a case report and literature review.

Background: Congenital anomalies of the kidneys and urinary tract (CAKUT) comprise a large spectrum of congenital malformations, and combined manifestations of CAKUT spectrum could coexist in the same person, which make the management more challenging. We present a rare clinical case of left incomplete duplex kidney with calculus and homolateral ureterovesical junction obstruction (UVJO) that occurred in a female adult, and report the combined surgical management of lithotripsy by flexible ureteroscopy with holmium laser, and refitting the ureter into the bladder after resection of the affected segment. Case Description: A 34-year-old female presented to our outpatient with the chief complaints of intermittent left flank pain for a week. The patient was diagnosed of renal calculus and hydronephrosis on the left side by abdominal color Doppler ultrasound, and intravenous pyelogram (IVP) revealed left incomplete duplex kidney, and UVJO, meanwhile, computerized tomography (CT) scan revealed the calculus located in the lower moiety of the incomplete duplex kidney, and the diameter of it was about 1.8 cm. The patient was diagnosed of left incomplete duplex kidney with calculus, hydroureteronephrosis and UVJO homolaterally. The flexible ureteroscopy with holmium laser was applied to remove the calculus, following a double-J ureteral stent insertion. The ureterovesical reimplantation was performed synchronously. The postoperative recovery and follow-up were uneventful. Conclusions: This report documents a rare case of multiple renal anomalies that included left incomplete duplex kidney with calculus, hydronephrosis, and homolateral UVJO. Flexible ureteroscopy with holmium laser is a safe and feasible option to manage the calculus in the incomplete duplex kidney, and homolateral UVJO can be effectively treated by vesicoureteral reimplantation in one operation.