A patient with bilateral DJ tube secondary stones was admitted recently, the management process was complicated, and I learned a lot of experience in this process, which I now share with you. A 68-year-old female patient, 10 years after urothelial cancer surgery, had a long-term suprapubic cystostomy for urinary drainage. This is a preoperative CT of the bladder. This is a preoperative CT of the bladder, which shows that the bladder is full of stones. The cystostomy tube was also clearly visible. This is a CT of the double J-tube after 2 months. Right Left After 3D reconstruction The event of secondary stones in the DJ-tube has been reported in the literature, mostly after long-term retention. However, it is rare to have such a large number of stones in a 2-month period, and it is the first time we have encountered it in our department. Based on the literature search of domestic and international centers, we developed a “sandwich” treatment with extracorporeal shock wave, intracorporeal lithotripsy, and extracorporeal shock wave. The left side was treated first with ESWL of the upper stone, and then ureteroscopic pneumatic ballast lithotripsy was performed 5 days later. Because the patient’s urethra was completely cut, he could only enter through the cystostomy, and given the restricted angle, the ureteroscope could not reach the upper ureter. This is a flat film of KUB after the first operation. The left DJ tube was removed and the ureteral catheter was temporarily left in place to drain the urine. The right side was treated in the same way, but because there was a large stone in the right kidney, the DJ tube could not be extracted during the first ESWL followed by ureteroscopic pneumatic ballast lithotripsy, and a week later, a second ESWL was performed to break up the upper stone, which was successfully extracted under cystoscopy. This is the KUB after extraction of the right DJ tube. It can be seen that most of the stones in the ureters were discharged bilaterally, and the remaining stones in the right kidney were left for ESWL treatment. The patient was discharged 2 days later and the ureteral catheter was removed one week later. This is the extracted DJ tube and the white tube on the kidney side is seen to be eroded to purple.