病例報告:軟式輸尿管鏡在輸尿管結石導致嚴重扭曲的N型及逆N型輸尿管之應用

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: Flexible ureteroscopy (fURS) for N-type and reverse N-type kinking ureter caused by stone obstruction

Chun-Kai Chang、Tsung-Yi Huang

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

It is generally accepted that the ureter descends straight in the retroperitoneal space. However, on retrograde pyelography or computed tomography (CT) urography performed routinely in clinical practice, kinking of the upper ureter often occurs near its crossing over the ipsilateral gonadal vein or stone obstruction related.

In the past year, while severe hydronephrosis with kinking ureter caused by stone obstruction, percutaneous nephrostomy(PCN) and/or antegrade JJ stenting were inserted first for renal pelvis decompression. And ureter might be straight after PCN insertion. After that ureteroscopic lithotripsy(URSL) can be arranged. Now, due to development of flexible ureteroscopy(fURS), in the same situation, flexible ureteroscopy (fURS) can be inserted via access sheath, either N-type or reverse N-type ureter can pass via flexible ureteroscopy (fURS) and then stone can disintegrated by laser and removed by basket. Finally, the hydronephrosis can be resolved by double J indwellation.

During the last decades, the surgical management of kidney and upper ureter stones benefited of many technological advances and one of them is the development of flexible ureteroscopy (fURS). This tool, ancillary equipment such as graspers and baskets, and lithotripsy technique with laser underwent many improvements leading to a widening of its indications with diagnostic and therapeutic management of upper urinary tract stone. In our opinion, flexible ureteroscopy (fURS) can treat N-type and reverse N-type ureter caused by complete stone obstruction.