Triple jeopardy: Blind-ending ureter harboring calculus, ureteral tumor with severe hydronephrosis

The kidney is a precious organ, the survival of which can be endangered by hydronephrosis, which is usually a consequence of obstructive ureteral pathologies. The blind-ending ureter, ureteral calculus, and ureteral tumor form a triple jeopardy that can put a kidney at risk of developing end-stage renal disease (ESRD). This is a case of a 70-year-old retired farmer who presented with colicky left flank pain and swelling for 10 months, associated with constitutional symptoms of malignancies. He was chronically ill-looking, febrile, pale, and dehydrated with an asymmetrically distended and vaguely tender abdomen, marked over the left lumbar area. The imaging findings were severe left pyoureteronephrosis, large impacted left distal ureteral calculus with a non-functioning left kidney, and a normal functioning right kidney. He had undergone a left nephroureterectomy on account of the incidental finding of a huge left tumor in a blind-ending ureter confirmed histologically to be an invasive papillary urothelial cell carcinoma of the ureter. The coexistence of ureteral tumor and calculus has been reported, but an unfamiliar occurrence of these in a blind-ending ureter presents a triple jeopardy that could result in ESRD.