NDP102: Paratesticular dedifferentiated liposarcoma : a rare case report
關於異位輸尿管插入前列腺尿道中的「失蹤結石」的病例報告
許玄昀1,2、高建璋1、曹智惟1、蒙恩1、吳勝堂1、查岱龍1、顏敬恆3
國防醫學院三軍總醫院外科部泌尿科1;
國軍桃園總醫院外科部泌尿科2;
三軍總醫院松山分院外科部泌尿外科3;
A case report on a ‘missing stone’ in an ectopic ureter that inserts into the prostatic urethra
Hsuan-yun Hsu1,2, Chien-Chang Kao1, Chih-Wei Tsao1, Meng En1, Sheng-Tang Wu1, Tai-Lung Cha1, Ching-Heng Yen3
Division of Urology, Department of Surgery
Tri-Service General Hospital, National Defense Medical Center1 ;
Division of Urology, Department of Surgery
Armed Forces Taoyuan General Hospital2;
Division of Urology, Department of Surgery, Tri Service General Hospital Song-shan Branch, Taipei, Taiwan3
Ureteral duplication is not an uncommon anomaly of the urinary tract and there have been few cases reported of ureteral stones in completely duplicated systems. However, a stone located in an ectopic ureter inserting into the prostatic urethra is very rare.
Here we report a case of 39-year-old male who had calculus in duplication ureter with ectopic orifice. He presented with left flank colic pain. A stone in left lower third ureter was detected by non-contrast enhenced CT. No stone was found under endoscopic vision and retrograde pyelography showed the calculus not within the course of observed ureter. However, colic pain persisted after surgery. Intravenous pyelography was arranged for ruling out duplication of ureter. The image confirmed the stone in duplication ureter which have an ectopic ureter orifice inserted below bladder neck. Second-time ureteroscopy revealed the ectopic orifice in prostatic urethral near the verumontanum by detecting active flow of urine with contrast agent. Ureteroscope was able to pass into the ectopic ureter without difficulty and the stone was successfully managed with laser lithotripsy.
Duplicated systems can be hard to appreciate on non-contrast enhanced CT although it has become the gold standard in diagnosis of renal calculus. This case report highlights the importance of contrast image study and skill for searching the ectopic ureter inserting to the prostatic urethra.