病例報告及文獻回顧: 輸尿管支架硬殼形成於輸尿管皮膚造口術病人之手術處理

李亞哲、周詠欽、沈正煌

嘉義基督教醫院 外科部 泌尿科

Surgical management in double-J stent encrustation in the ureterocutaneostomy patient: A case report and review of the literature

Ya-Che Lee, Yeong-Chin Jou, Cheng-Huang Shen

Divisions of Urology, Department of Surgery, Chiayi Christian Hospital

Introduction:

The double-J stents encrustation in the ureterocutaneostomy patient is rare. There are many choices of surgical treatment. This article will illustrate considerations of surgical management in an ureterocutaneostomy patient complicated with double-J stent showing severe encrustation.

Case presentation:

A 78-year-old Asian male with history of 1. urothelial carcinoma of the right ureter status post nephroureterectomy with bladder cuff excision in 2009. 2. urothelial carcinoma of the bladder status post radical cystoprostatectomy + pelvis lymph node dissection + left ureterocutaneostomy in 2015. Since 2015, double-J stents were placed inside the ureters and changed every 12 weeks. This time the patient was admitted to our hospital due to difficulty of change double-J under local and sterile conditions. The KUB and abdominal CT revealed encrustations involved the upper coil of the stent with large stone burden.   Due to progressive urinary tract infection (UTI), deteriorating renal function, and hematuria, the patient underwent ureteroscopic lithotripsy (URSL). Encrustations on double-J was diagnosed and ureteroscopy assisted fragmentation of stones using a laser device were done. A new double-J stent was also inserted.

Discussion:

Change of a double J stent through ureterocutaneostomy can be easily realized under local conditions by delivering a soft, flexible catheter through the stent. However, this is an ureterocutaneostomy patient with double-J stent severe encrustation, which made the removal of impacted double J difficult. There is no golden indication illustrated which surgical treatment is the best choice. In this case, there were some reasons to perform surgical management. After URSL and double-J stent insertion, complicated UTI was under control and renal function got improved.

Conclusions:

Encrustation is one of the most difficult complications of ureteral stents and its management is a complex clinical scenario for the treating surgeon. The combination of several surgical techniques is necessary but the best treatment remains the prevention of this problem by providing patient education.