常見內視鏡膀胱碎石併單側診斷性輸尿管鏡手術引起的少見併發症-病例報告

曾博鴻、嚴孟意

彰化基督教醫院 外科部 泌尿科

Rare complication of common endoscopic cystolitholapaxy with unilateral diagnostic ureteroscopy: a case report

Po-Hung Tseng, Meng-Yi Yan

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction:

Bladder stones account for 5% of urinary stones in the developed countries but for more in the developing countries. Transurethral cystolitholapaxy is probably the most common way to manage cystolithiasis. This technique require anesthesia, hospitalization and are associated with some morbidities such as hematuria, bladder perforation and urethral injury. Bilateral hydronephrosis with acute renal failure has not been reported as a complication.

Case report:

We presented a case of 35-years-old male. This patient suffered from intermittent fever and left lower abdominal pain for 2 days before he came to Changhua christian hospital emergency room at first. Lower urinary tract symptoms included hematuria, dysuria and voiding hesitancy. Kidney sonography showed bilateral tiny renal stones, bladder sonography showed several vesical stones. Thus, he was referred to urologist and he received endoscopic cystolitholapaxy for multiple vesical stones and left diagnostic ureteroscopy for unknown left abdominal pain. After surgery, anuria was noted at ward on post-operative first day, serum creatinine elevated from 0.80 to 2.65 mg/dL, acute renal failure was impressed. Emergent kidney sonography showed bilateral hydronephrosis. Then emergent bilateral diagnostic ureteroscopy was performed. Bilateral ureteral orifices were swelling and occluded with blood clot under cystoscopic examination. Double-J was inserted to bilateral ureter. Follow-up creatinine was improved on the next day. Foley's catheter was removed 3 days later. Due to his improved condition and smooth urination, he was discharged and urology outpatient department follow up.

Conclusion:

Although endoscopic cystolitholapaxy is the common surgery of vesical stones, morbidities could not be neglected. We suggest always check location of ureteral orifice to protect and prevent injury during operation. Attention to post-operative anuria at first day, it could represent postrenal acute kidney injury. Check creatinine and kidney sonography were necessary to diagnose. Prophylactic lasix is suggested especially for suspected swelling of ureteral orifice after surgery, it depends on surgeon.