Pyonephrosis Associated with Massive Nephrolithiasis and Spontaneous Steinstrasse Managed by Open Nephroureterectomy: A Case Report
Keywords:
Pyonephrosis, Nephrolithiasis, Spontaneous steinstrasse, Nephroureterectomy, Open urological surgeryAbstract
Introduction: Pyonephrosis is a urological emergency caused by suppurative infection of an obstructed renal collecting system, most commonly due to urolithiasis. Steinstrasse is typically encountered as a complication following extracorporeal shock wave lithotripsy, whereas spontaneous steinstrasse in the absence of prior intervention is exceedingly rare. Its coexistence with massive nephrolithiasis and pyonephrosis represents an unusual and challenging clinical scenario.
Case Presentation: We report a rare case of pyonephrosis secondary to an obstructing renal pelvic stone, associated with multiple nephrolithiasis and spontaneous steinstrasse. The patient presented with chronic flank pain and was found on imaging to have extensive stone burden involving the kidney and a continuous chain of calculi along the ureter. Despite preserved laboratory parameters, radiological findings suggested a chronically obstructed and infected, non-functioning renal unit. Considering the severity of infection and extensive ureteral involvement, a double-incision open nephroureterectomy was performed. Intraoperatively, more than 50 calculi were removed from the kidney and ureter. The postoperative course was uneventful, and follow-up imaging demonstrated complete stone clearance.
Conclusion: Pyonephrosis associated with massive nephrolithiasis and spontaneous steinstrasse is extremely rare and potentially life-threatening. In the presence of severe infection and a non-functioning kidney, open nephroureterectomy offers definitive source control. This case underscores the continued relevance of open surgery in selected complex urolithiasis cases despite advances in minimally invasive techniques.
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References
Tamburrini S, Lugarà M, Iannuzzi M, Cesaro E, De Simone F, Del Biondo D, et al. Pyonephrosis Ultrasound and Computed Tomography Features: A Pictorial Review. Diagnostics 2021, Vol 11, [Internet]. 2021 Feb 17 [cited 2026 Feb 1];11(2). Available from: https://www.mdpi.com/2075-4418/11/2/331 doi: 10.3390/DIAGNOSTICS11020331
2. Abderrahmane D, Mahmoud A, Mehdi S, Amine M, Mohamed D, Adil D, et al. Managing of Pyonephrosis: About 42 Cases. Mathews Journal of Urology and Nephrology [Internet]. 2024 May 21 [cited 2026 Feb 1];6(2):1–5. Available from: https://doi.org/10.30654/MJUN.10021 doi: 10.30654/MJUN.10021
3. Erol A, Çoban S, Tekin A. A Giant Case of Pyonephrosis Resulting from Nephrolithiasis. Case Rep Urol [Internet]. 2014 Jan 1 [cited 2026 Feb 1];2014(1):161640. Available from: /doi/pdf/10.1155/2014/161640 doi: 10.1155/2014/161640
4. Parmar K, Manoharan V, Kumar S, Ranjan KR, Chandna A, Chaudhary K. Large spontaneous steinstrasse: Our experience and management issues in tertiary care centre. Urologia Journal [Internet]. 2022 May [cited 2026 Feb 1];89(2):226–30. Available from: /doi/pdf/10.1177/03915603211001174?download=true doi: 10.1177/03915603211001174
5. Dimov N, Valcheva E, Vaysilova M, Artinyan E. Spontaneous steinstrasse—a rare clinical case report. J Surg Case Rep [Internet]. 2025 May 31 [cited 2026 Feb 1];2025(6). Available from: https://dx.doi.org/10.1093/jscr/rjaf455 doi: 10.1093/JSCR/RJAF455
6. Liang X, Huang J, Xing M, He L, Zhu X, Weng Y, et al. Risk factors and outcomes of urosepsis in patients with calculous pyonephrosis receiving surgical intervention: a single-center retrospective study. BMC Anesthesiology 2019 19:1 [Internet]. 2019 May 1 [cited 2026 Feb 1];19(1):61-. Available from: https://link-springer-com.unpad.idm.oclc.org/article/10.1186/s12871-019-0729-3 doi: 10.1186/S12871-019-0729-3
7. Tezcan E, Burrell R, Bell DJ, Almpanis S. Spontaneous resolution of a spontaneous steinstrasse: a case report. J Surg Case Rep [Internet]. 2018 Oct 1 [cited 2026 Feb 1];2018(10). Available from: https://dx.doi.org/10.1093/jscr/rjy252 doi: 10.1093/JSCR/RJY252
8. Donega Yaméogo CAMK, Kaboré M, Sawadogo H, Kirakoya B, Paré AK, Traoré TM, et al. Spontaneous steinstrasse: A case report and literature review. Urol Case Rep [Internet]. 2026 Jan 1 [cited 2026 Feb 1];64:103268. Available from: https://www-sciencedirect-com.unpad.idm.oclc.org/science/article/pii/S2214442025003390 doi: 10.1016/J.EUCR.2025.103268
9. Kundargi V, Patil S, Shukla V, Patil SB. Spontaneous occurrence and expulsion of a massive Steinstrasse. BMJ Case Reports CP [Internet]. 2024 Feb 1 [cited 2026 Feb 1];17(2):e259065. Available from: https://casereports.bmj.com/content/17/2/e259065 doi: 10.1136/BCR-2023-259065
10. Spessoto LCF, Aguiar RS, Gonzales GC, Spessoto ACN, Jr. FNF, Spessoto LCF, et al. A Rare Case of Spontaneous Steinstrasse. Cureus [Internet]. 2023 Nov 29 [cited 2026 Feb 1];15(11). Available from: https://cureus.com/articles/208561-a-rare-case-of-spontaneous-steinstrasse doi: 10.7759/CUREUS.49641.
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