CYSTOSCOPY IN LOWER URINARY TRACT SYMPTOMS IN POSTMENOPAUSAL WOMEN : FINDING OF LOWER URETERIC CALCULUS AS A SURPRISE

There are three physiological narrowings in the ureter.The first one at the PUJ , second one at the iliac vessel crossing and the third at the  intramural portion of the ureter joining  the bladder known as the ureteral vesico-junction, or UVJ, which measures approximately 1 - 5 mm. in size. The majority of stones become stuck at this level. Once a calculus reaches the distal ureter and approaches the bladder, symptoms of vesicle irritation are frequently noted.

Many a times the patients present only with irritative symptoms so a USG imaging on a full bladder is necessary for evaluation of the UVJ calculus.

But if the bladder cannot be made full because of intense urgency and irritation then lower ureteric calculus can be missed.

We had 56 year old postmenopausal lady presenting with LUTS. She was not having any comorbdities.Her USG abdomen revealed bilateral small calculi but no hydronephrosis or ureteric calculi.Her Urine culture report was sterile.She was being treated for many weeks with antibiotics and bladder spasmolytics like Urispas/pyridium by outside doctors.

The lady came to us; as she had already taken long antibiotic therapy and her culture were sterile ; we decided to go ahead with cystoscopy.

FALLACY OF EMPTY BLADDER IN DETECTING THE LOWER URINARY TRACT CALCULI

To our surprise we came across a stone popping out of the ureteric orifice.We fragmented the stone with LASER ithotripsy and kept a ureteric catheter.

pearl of wisdom:In cases of refractory lower urinary tract symptoms ; PLAIN CT SCAN KUB is a better imaging if bladder cannot become distended.