順行性軟式輸尿管鏡碎石手術在複雜輸尿管結石的應用:腎移植及輸尿管迴腸吻合術病人

張君愷、黃琮懿

高雄醫學大學附設中和紀念醫院 泌尿部

The Application of Antegrade Flexible Ureteroscopy(Furs) for Difficult Ureter Stone Scenario: Kidney Transplantation and Urinary Diversion

Chun-Kai Chang、Tsung-Yi Huang

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Purpose: The management for urolithiasis in kidney transplantation and urinary diversion is

challenging. We share experience in our institution with antegrade flexible ureteroscopy(fURS)

for these difficult ureter stone scenarios.

Materials and Methods: The surgical technique was described below. All the patients were inserted

10 Fr. percutaneous nephrostomy (PCN) tube in the middle calyx before the operation. During

operation, the patient was positioned in the Galdakao-modified supine Valdivia position, similar to

that in endoscopic combined intrarenal surgery(ECIRS). In this position, both antegrade and retrograde

can be performed simultaneously. A terumo guidewire was sent through the PCN then, the other side

of the guidewire was down to the bladder. After that, the PCN wound was dilated to 12 Fr., and an

11/13 Fr. 36 cm access sheath was inserted to renal pelvis via guidewire. In this process, C-arm was

used for checking the proper position. After that, a flexible ureteroscope could be introduced to the

ureter through the access sheath. We disintegrated the stone with a Holmium laser and removed the

stone fragment with a stone basket. After clearance of stone, double J was indwelled.

Results: From January 2017 to March 2020, we retrospectively analyzed the medical records of all

patients who underwent antegrade flexible ureteroscopy(fURS) with difficult ureter stone scenario in

our institution. 1 kidney transplantation and 3 ileal conduit patients with ureteral stone were noted in

our institution. All the patients had stone free after surgery. None of the patients had encountered sepsis

or needed blood transfusion after operation.

Conclusions: Treatment for urolithiasis in kidney transplantation and urinary diversion is challenging,

and the management should be specialized by individual patients. Our experience showed antegrade

flexible ureteroscopy(fURS) is a feasible and reproducible option for treating difficult ureter stone

scenarios.