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While the goal of percutaneous management of renal and ureteral calculi is stone extraction or disintegration, perforation of the renal pelvis or ureter may allow stones or stone fragments to become extruded during endourologic manipulations. The authors have encountered six such patients: two with renal and four with ureteral calculi. Three stones were extruded into the perinephric or periureteric tissues during nephroscopy, two during attempted dislodgement with a balloon catheter, and one during antegrade passage of a ureteral catheter. All patients were managed conservatively by means of nephrostomy drainage and, in the four cases of ureteral laceration, ureteral stenting. Follow-up study, ranging from 12 to 24 months, has documented a benign clinical and radiological course. No ureteral strictures have ensued. In the absence of infected urine, urothelial laceration with calculus extrusion appears to be a benign occurrence and may be managed conservatively.

Routine follow-up urography demonstrated pseudoureteroceles caused by impacted calculus fragments in the distal portion of the ureter in five patients who had undergone extracorporeal shock wave lithotripsy of renal calculi 4-6 weeks before. Although all five patients showed some degree of obstruction at the time of follow-up urography, four were asymptomatic. Either small isolated fragments (two patients) or a column (steinstrasse) of fragments (three patients) was responsible for the abnormality. Two patients required further intervention to relieve the obstruction.