逆行性腎內手術有效治療單側游離腎合併尿路結石的案例

蘇奕瑋、黃建榮、薛又仁、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

Retrograde intrarenal surgery effectively treated a case of urolithiasis with unilateral ectopic kidney

Yi-Wei Su, Andy C. Huang, Thomas Y. Hsueh, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Nephrotosis, also known as a floating kidney, is defined as the descent of the kidney by 5 centimeters or more (equivalent to 2 vertebral bodies) in an upright position. While it is often asymptomatic, nephrotosis can lead to a range of symptoms, including flank pain, nausea, vomiting, and, in some cases, hypertension or urinary issues. In this case report, we present a 78-year-old man with right nephroptosis who had stag horn kidney stones and upper ureter stones, which were successfully treated with Retrograde Intrarenal Surgery (RIRS).

Case presentation: 

A 78-year-old man with a medical history of benign prostate hyperplasia, colon cancer, hypertension, hepatitis B carrier status, Inflammatory Bowel Disease (IBD), and fatty liver, presented to our urology outpatient department with complaints of hematuria and right flank pain. A renal echogram revealed right hydronephrosis. An attempt was made to perform a right Ureteroscopy (URSL) but was unsuccessful due to the severe tortuosity of the ureter. A Double-J stent was placed, and an abdominal CT was subsequently performed for a more detailed image. This revealed the presence of stag horn stones in the right kidney and upper ureter stones.

Follow-up biochemistry examinations indicated an elevation in serum creatinine and blood urea nitrogen (BUN), suggesting acute kidney injury likely related to the stones. After discussing the treatment options with the patient, we proceeded with Retrograde Intrarenal Surgery (RIRS). Following the surgery, an improvement in renal function was observed, and the patient was discharged without complications.

Conclusion:

        The management of nephrotosis complicated by renal stag horn stones and upper ureter stones requires a comprehensive preoperative evaluation. Initial medical treatment with broad-spectrum antibiotics should be followed by interventions such as Extracorporeal Shock Wave Lithotripsy (ESWL), RIRS, or even pyelolithotomy. In patients with nephrotosis who experience recurrent stone formation or persistent symptoms, nephropexy may be a consideration. Ongoing follow-up in these cases is of utmost importance.