Patient with known nephrolithiasis.  Presented with right sided renal colic and fever.

Initial plain film shows bilateral renal calculi.  CT-KUB bilateral renal stone disease and hydronephrosis.  On ultrasound the right sided hydronephrosis is illustrated and left staghorn calculus. 

Percutaneous nephrostomy performed, which identified a pyonephrosis.

Subsequent to this ureteroscopy and stone removal performed and placement of a retrograde ureteric stent.

The final plain abdominal radiograph shows a left staghorn calculus, right sided percutaneous nephrostomy and ureteric stent.