螺旋重複盆腔馬蹄腎之完整鹿角結石-案例報告

黃亮臻,陳建華

恩主公醫院外科部泌尿科

Complete Staghorn Stone of Rotated Duplicated-pelvicalyceal Horseshoe Kidney

Liang-Chen Huang, Chien-Hua Chen

Division of Urology, Department of Surgery, En Chu Kong Hospital

Abstract:

    A 60-year-old female suffering from right flank pain and intermittently gross hematuria for three months came to our Urology clinic for assistance. KUB showed a 9.5 cm complete staghorn stone occupying her right rotated duplicated renal pelvicalyces. To differentiate the relationship between her duplicated pelvicalyces, intravenous pyelography revealed a fulfilled right rotated duplicated renal pelvicalyces with patent ureter and bilateral inward-expanding renal calyces which hinted a horseshoe kidney (Figure). Further computed tomography scan confirmed a parenchymal isthmus horseshoe kidney with type II vessel anatomy, where ectopic arteries arised from distal aorta in addition to the orthotopic renal arteries. This is an inspirational scenario for nephrolithiasis management, which is a candidate of multi-tract percutaneous nephrolithotomy (PCNL), endoscopic combined intrarenal surgery with or without concurrently laparoscopic pyelolithotomy, or multi-stage surgery. After patient-centered shared decision making, she experienced one PCNL followed by one flexible ureteroscopy and laser lithotripsy three weeks later; and extracorporeal shock wave lithotripsy for a tiny residual stone at right lower renal calyx at last follow-up