高雄市阮綜合醫院 外科部 泌尿科
Renal stones outlet obstructed by pararenal pelvic cyst management
Ping-Ju Tsai, Cheng-Chen Su, Chung-Sung Shen, Shih-Ya Hung
Division of Urology, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan
We often incidentally indentified some renal cysts at OPD. The principles of non-obstructive simple renal cysts management is watchful waiting. However, some renal cysts need to be managed, such as malignancy tendency, renal pelvic-ureteral junction obstruction by those cysts. The management of renal cysts included aspiration combined with injection of scloerosing materials, and laparoscopic unroofing.
We presented a 60-year-old male who has multiple low calyceal stones with focal hydrocalyx. The renal pelvic-ureteral junction was extrinsic compressed by one large parapelvic renal cyst. First, non-enhanced abdominal CT scan was arranged and thus we clearly know the relative locations of cyst and pelvic-ureteral junction. Laparoscopic unroofing of renal cyst was performed. After surgery, we arranged intravenous pyelogram for confirming the pelvic-ureteral junction patency. Watchful waiting for spontaneous passage of multiple small renal stones was planned. Unfortunately, stone streets formations in low third and upper third ureter were found later. Ureteroscopic lithotripsy and double-J catheter were performed smoothly. Extraperitoneal shock wave for residual renal stones was performed, too. Last, we removed the double-J catheter. The clearance of renal stone was excellent.