[Giant hydronephrosis associated with ureterocele complicated by ureteral lithiasis]

Giant hydronephrosis is defined as an extensive dilation of the pyelocaliceal cavities occupying a large part of the abdominal cavity or as a dilation filled up with more than a liter of urine overflowing the median line. This is due, more often, to pyelo-ureteral junction syndrome. Obstruction due to ureterocele complicated by lithiasis is a very rare cause of giant hydronephrosis. We here report the case of a 45-year old patient with a history of right lumbar pain which hadn't been investigated, presenting with abdominal mass evolving over the last few years associated with intermittent constipation. Clinical examination showed asymmetrical abdominal distension with dullness above the median line. Ultrasound showed multi-compartmentalized fluid-filled mass occupying all the right abdominopelvic region and pressing the digestive structures. Uroscanner showed right giant ureteropyelocaliceal dilation (pyelon measuring 15.2cm) completely eroding the renal parenchyma with absence of contrast agent excretion, upstream of ureterocele complicated by a stone measuring 2cm. Laparoscopic nephroureterectomy was performed. Post-operative suites were simple.