LAUSR

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal. A 71-year-old man presented with right back pain and hematuria for 1 week. The patient had pronounced anemia, and his hemoglobin level had dropped from 142 to 76 g/L because of the hematuria. The patient had no obvious urinary frequency, dysuria, or urgency, nor did he have a fever. Physical examination showed no positive findings except for pain in the right renal region on palpation. Urinalysis revealed that his white and red blood cells [WBC 60/high power field (HPF), RBC 90/HPF] were significantly increased. Ultrasound examination showed that the right renal pelvis was separated by 18 mm, that the upper segment of the right ureter was dilated by 16 mm, and that there was a 22 mm × 13 mm strong echo with acoustic shadow 72 mm away from the renal hilum. The enhanced spiral computed tomography (CT) showed multiple stones in the right kidney, the largest being 20 mm × 13 mm, and the right renal pelvis and ureter were obviously dilated. CT confirmed the presence of a periureteral venous ring (Figures 1,2). Unfortunately, no measurement of glomerular filtration rate was performed to assess renal split function due to lack of equipment. A retroperitoneal laparoscopic reconstruction of the ureter was performed with excision of the retrocaval segment of the ureter and uretero-ureteral anastomosis (Figure 1). Three months after reconstruction, the patient’s hemoglobin returned to 135 g/L. Flexible ureteroscopy and holmium laser lithotripsy were performed for the pelvic renal calculi, and the indwelling catheter was removed 1 month after lithotripsy (Figure 3). After 18 months, the patient’s hemoglobin and urinalysis were normal, with no low back pain (Figure 2).