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BACKGROUND Retrograde intrarenal surgery (RIRS) has been proven to be a safe and effective treatment modality in large-scale quantitative studies. However, although its safety profile has been established, it also has a potential risk of life-threatening complications. We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy. CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria. An enhanced computed tomography (CT) scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis. The patient underwent RIRS. During the surgery, a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter. On postoperative day 1, she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness. A follow-up CT scan was taken, which revealed a huge hematoma in the periureteral space, not in the perirenal space, with suspicious contrast medium extravasation. Immediate angiography was performed; however, it showed no evidence of active bleeding. She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy, and was discharged on postoperative day 7. However, she visited our outpatient department with recurrent left flank pain at 5 d from discharge. Ultrasonography confirmed that the double J-stent was intact. To rule out stent malfunction, the stent was changed. Decreased size of the hematoma was observed in the imaging studies, and conservative management for candiduria was performed for 1 wk. CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones, clinicians should be aware of its potential complications.

BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication, horseshoe kidney, or crossed renal ectopia. CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux (VUR). In this condition, recurrent febrile urinary tract infection can be a serious problem, and can easily cause renal damage due to relatively short ureters and high pressure in the kidney. CONCLUSION To prevent urosepsis and preserve renal function, early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.