DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.046

Pages: 781-784

Adults with repaired bladder exstrophy may develop late upper urinary tract obstruction and stone disease due to complex reconstructed anatomy. Obstructive acute pyelonephritis is a urological emergency requiring urgent drainage and antimicrobial therapy, followed by delayed definitive stone treatment once infection is controlled. We report the case of a 31-year-old man with a history of bladder exstrophy reconstruction, including bilateral ureteral reimplantation in infancy and a Mitrofanoff catheterizable channel, who presented with febrile right flank pain. Computed tomography demonstrated right hydronephrosis caused by a large distal ureteral stone [30 × 13 mm; 1200 HU] at the iliac segment, associated with severe stenosis at the reimplanted ureteral orifice. He received intravenous antibiotics and urgent right percutaneous nephrostomy drainage. Renal scintigraphy performed after infection resolution showed reduced right differential renal function [22%]. Definitive surgery was performed via a right iliac approach. The stone was extracted through ureterotomy; double-J stent placement was initially impossible due to tight terminal ureteral stenosis. The ureter was transected proximal to the stenosis, a double-J stent was placed, and redo ureteroneocystostomy was completed after bladder identification by filling through the Mitrofanoff channel. Postoperative recovery was uncomplicated, with drain removal on postoperative day 2, nephrostomy removal intraoperatively, and discharge after 5 days. The ureteral stent was removed 1 month later. Follow-up to date is favorable, with no dilation on imaging and serum creatinine improving to 9 mg/L.