病例報告: 逆行性軟式輸尿管鏡腎內碎石手術在雙側馬蹄腎結石的應用及相關文獻討論

張君愷、黃琮懿

高雄醫學大學附設中和紀念醫院 泌尿部

Case report: Bilateral horseshoe kidney stones treated by retrograde intrarenal surgery and literature review

Chun-Kai Chang、Tsung-Yi Huang

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

The horseshoe kidney(HSK) is the most common type of renal fusion anomaly. It consists of two distinct functioning kidneys on each side of the midline, connected at the lower poles (or rarely at the upper poles) by an isthmus of functioning renal parenchyma or fibrous tissue that crosses the midline of the body. Urolithiasis is the most common complication of HSK, affecting 20%–60% of cases and the successful management of these stones is considered by many to be a conundrum

Our case was a 62-year-old male who had urolithiasis and horseshoe kidney history. He had suffered from left flank soreness for several years and then went to other hospital for help. Bilateral renal stone was noted, and treatment by open pyelolithotomy and percutaneous nephrolithotomy (PCNL) but failed. After that he came to our outpatient department for help. Bilateral retrograde intrarenal surgery was arranged. Flexible ureteroscopy(fURS) was inserted via access sheath, 1.5cm left renal stone was noted and then disintegrated by laser, and the stone fragment removed by basket. Multiple small right renal stones were also found and removed by basket. Follow up KUB showed stone free.

Indications, methods of treatment, and outcomes of management of stones associated with HSK were comparable to those for stones associated with normal kidneys. The management needs to be individually tailored according to stone size and burden, with the possibility of conservative management.

Various methods are indicated for the management of stones associated with HSK, including percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL), which are the most commonly used methods. More recently, flexible ureteroscopy (fURS) has also been shown to be effective.