探討治療尿路結石發生在單側雙套腎合併雙套輸尿管的案例

黃泓翔¹、鍾旭東¹、鄭百諭^1,2

¹亞東紀念醫院 外科部 泌尿外科; ²國立台灣大學醫學工程學系

Urolithiasis in unilateral duplex kidney with complete duplicated ureters

Hung-Hsiang Huang¹, Shiu-Dong Chung¹, Pai-Yu Cheng^1,2

Division of Urology¹, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan

Department of Biomedical Engineering², National Taiwan University, Taipei, Taiwan

Introduction

Duplex kidney involves two pelvicalyceal systems with two ureters draining into the bladder. The duplex kidney can have two ureters that fuse into one ureter (incomplete type) or have two ureters (complete type) that drain into the bladder separately. The two ureteral orifices of the complete duplex kidney are located differently in the bladder. Unrecognizing duplicate kidney timely in the first procedure may lead to serious morbidity in patients with stone impaction and infection.

Case report

A 58-year-old woman without any systemic disease presented to the emergency department with acute periumbilical colic pain. Associated symptoms included nausea and vomiting. The physical examination showed tenderness over her periumbilical area and right upper quadrant of the abdomen. The kidney, ureter, and bladder (KUB) X-ray and non-contrast-enhanced computerized tomography (CT) detected a right renal stone and a right ureteral stone. Her laboratory tests showed hematuria, pyuria, bacteriuria, and increased white blood cell count. Emergent treatment with right ureteroscopic examination was performed, but no stone was found.

After surgery, the patient experienced a septic shock, so central venous catheterization for vasopressor injection and empirical antibiotics treatment with Ertapenem were used. A KUB X-ray showed the right double-J stent positioned in her right ureter. The stone was still found next to the right double-J stent and the existence of a duplex kidney with double ureters was suspected. Therefore, a second ureteroscopic examination was performed and the second ureter with smaller ureteral orifice was found. The stone was located and fragmented over this second ureter. The patient gradually recovered and was discharged on the sixth day of hospitalization. In the following outpatient department follow-up, intravenous pyelography (IVP) of the patient showed the right duplex kidney with complete duplicate ureters.