醫源性輸尿管異位:機器手臂攝護腺切除術之併發症
林才揚、洪順興、黃冠華1、沈坤宏
奇美醫學中心 外科部 泌尿外科，1泌尿腫瘤科
Iatrogenic ectopic ureter: complication of robotic-assisted laparoscopic radical prostatectomy
Chye-Yang Lim, Shun-Hsing Hung, Steven K. Huang1 , Kun-Hung Shen
Division of Urology, Department of Surgery, 1Division of Uro-Oncology
Chi Mei Medical Center
Case description:
A 53 year-old male with the medical history of hepatitis B carrier. As family history of prostate cancer of his father, he presented to our urologic outpatient department for survey. Due to elevation of PSA level, prostate biopsy was done which revealed adenocarcinoma. Clinical staging was cT3aN0M0. However, he underwent robotic-assisted laparoscopic radical prostatectomy at other hospital. Final pathology revealed prostate adenocarcinoma, pT2cN0M0. After operation, he suffered from abdominal and urethral pain for about 1 month with a CWV and a Foley catheter retained. Therefore, he returned to our OPD for further survey.
Physical examination revealed lower abdominal tenderness. Meanwhile massive clear yellowish drainage from CWV noted daily (around 1500 to 2000 ml/day) and its creatinine level was 13.68mg/dL. There was no evidence of intraabdominal infection by ascites analysis. Under suspicious of anastomotic site leakage, he was admitted for a series of examination and treatment. Firstly, exchanged of urethral Foley was done, follow by cystoscopic examination which inflammatory change of trigone noted but right ureteral orifice could not found. Then, cystography illustrated no contrast medium leakage. After review post-OP CT scan of the hospital where operation done, progression of right hydronephrosis and suspicious contrast leakage at right UVJ area. In order to relief right hydronephrosis, PCN was performed. Then antegrade pyelography arranged which revealed urinary leakage from inferior aspect of urinary bladder near right UVJ. As iatrogenic injury of right ureter was noted, right JJ stent inserted via antegrade fashion by radiologist.
After that, the drainage from CWV getting decreased and the condition of abdominal pain subsided. Finally, the Foley catheter and CWV drain were removed under the relative stable condition. No urinary retention but incontinence noted. Further details during follow up and discussion will be presented in the near future.