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what is your opinion?      8/10/2011

a 43 year old male underwent left renal SWl for a 13 mm pelvis stone 15 months ago, he bared painful episodes of stein strausse in lower left ureter the following month therefore  ureteroscopic  holmium laser lithotripsy was carried out  13 months ago; a Dj stent was placed due to ureteral stricture for 5 weeks and was withdrawn afterwards.

 after a year of follow up, he turned out to have a sever left side hydroureteronephrosis down to lt lower ureter with no evidence of stones in spiral CT scan. obstruction site is confirmed by MRU ( allergic to iodinated contrast) . Renal DTPA scan revealed nonfunctional left kidney  ( 93% vs 7% )ureteroscopy was done, sever left lower ureteral stricture was encounterd with pale urothelium and firm consistancy that neither the 6 FR ureteroscope nor 0.035 guide wire could  be passed.  .

what would be your next steps?

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