Medical expulsive therapy symptomatic aggravation in blind right orthotopic ureterocoele and contralateral impacted left ureteral meatus stones: A Case Report

A ureterocoele with stone may present with recurrent flank pain and urinary tract infection. Medical expulsive therapy (MET) may be associated with symptomatic aggravation when there is ureteric obstruction or stone impaction. The definitive treatment is by deroofing and retrieval of the stone endoscopically or by open intravesical approach. We report a case of symptomatic aggravation of right orthotopic blind ureterocoele stone and contralateral impacted left ureteral meatus stone following MET using tamsulosin who was treated by open deroofing and retrieval of stones.
Case presentation: This is a 17-year-old lady who presented with recurrent suprapubic colicky abdominal pain that was aggravated by Medical Expulsive Therapy (MET) using tamsulosin but improves with opioid analgesics. Abdominopelvic ultrasound done before MET revealed bladder stone but the repeat ultrasound after the MET revealed bilateral ureterocoele with stones. A computerized tomographic scan urogram (CTU) revealed a right ureterocoele stone and bladder stone. She had bladder exploration with the finding of blind right orthotopic ureterocoele containing stone measuring 2.5cm x 3cm and an impacted peeping left ureteric meatus stone of 1.2x1 cm. She had deroofing of the right ureterocoele and retrieval of the stones bilaterally. The stitches and stents were removed and discharged on 9 and 10 postoperative days respectively. The postoperative period was uneventful.
Conclusion: Medical expulsive therapy may be associated with symptomatic aggravation in blind orthotopic ureterocoele and sizeable impacted ureteral meatus stone. Findings of the Imaging studies may be conflicting and inaccurate. Deroofing of the ureterocoele and stone retrieval is associated with a good outcome.