Massive Ureterolithiasis in a Duplicated Ureter: A Case Report

This case study presents a patient with massive ureterolithiasis in a duplicated ureter. A 31-year-old female patient underwent two dual-energy X-ray absorptiometry (DEXA) scans, which incidentally revealed an ossific pelvic mass identified by a chiropractor. Pelvic X-ray and CT confirmed ureterolithiasis measuring 6.08 cm x 1.92 cm. Two months later, she developed left-sided lumbar pain radiating to the lower extremity, left lower quadrant abdominal pain, urinary urgency, and persistent fever requiring hospitalization. Clinical investigations, including urinalysis, blood work, and CT, confirmed a urinary tract infection secondary to ureterolithiasis. A follow-up CT scan revealed a completely duplicated ureter on the left side that had been missed on prior studies. The patient was treated with multiple courses of antibiotics over six weeks with limited clinical improvement; subsequently, a ureteral stent was placed. Approximately one month later, the calculus spontaneously passed into the bladder, resulting in significant symptomatic relief. A follow-up CT scan revealed a completely duplicated ureter on the left side that had been missed on prior studies and revealed that the previously placed ureteral stent had been inadvertently inserted into the unobstructed ureter. This case highlights the importance of thorough imaging review, as the urological pathology was initially detected on a DEXA scan. Timely recognition and referral are essential to optimizing patient outcomes in atypical presentations.