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+A 50-year-old man with a history of lumbar spine fixation due to herniated discs, who presented with coralliform lithiasis in the right renal pelvis, scarcely radiopaque, with pyelocaliceal dilatation and delayed elimination in the IVUS. Alkalinising treatment was administered with potassium citrate (Acalka) at a dose of one tablet every 8 hours for 3 months and a double J catheter was placed on the right. Subsequently, three sessions of extracorporeal shock wave lithotripsy were scheduled and IVUS was requested after the treatment, showing a functional annulment of the affected renal unit despite the placement of the double J catheter.
+
+To assess the functional status of the right kidney, an isotopic renogram and renal scintigraphy were performed with low isotopic uptake in the right kidney and a flat, obstructive curve after administration of the diuretic in the renogram. Total renal function of the right kidney was 9%.
+A right ureteroscopy was performed under anaesthesia in an attempt to identify the origin of the renal annulment. During the procedure, a long lumbar and iliac ureteral stenosis (8-10 cm) with no appreciable lithiasis was observed. A standard guide wire (Cordis, 150 cm long and 0.90 mm wide with a polytetrafluoroethylene coating) was advanced to the kidney and repeatedly dilated with a high-pressure pneumatic balloon (18 atmospheres) without resolving the ureteral stricture, given that during the dilatations the working guide wire was dragged with the balloon to a more distal position, a safety guide wire was also placed and advanced to the renal pelvis to prevent its displacement. Once the attempts at ureteral dilatation had been completed, it was decided to place a double J catheter, which ascended without any problems through the working guide. However, on attempting to remove the guidewire, it was observed that the intrapyelic loop had formed a knot that prevented it from being removed.
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+At this point, the patient was presented with two therapeutic options: percutaneous approach to remove the loop or nephrectomy, given the limited functionality of the right kidney and the long ureteral stricture, which was difficult to resolve with conservative measures.
+The patient opted for the second option, performing a right nephrectomy without significant operative incidences, and the patient was asymptomatic in successive visits to the outpatient clinic.
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