逆行性腎臟內手術移除腎實質內異物：病例報告及文獻探討

陳毅軒、張琮昕、陳建志、陳鈺昕

馬偕紀念醫院 泌尿科；¹馬偕醫學院 醫學系；²國立陽明大學 藥理學研究所

Retrieval of intrarenal foreign body from ruptured guidewire by retrograde intrarenal surgery: A case report and literature review

Yi-Hsuan Chen, Tsung-Hsin Chang, Marcelo Chen¹, Yu-Hsin Chen^1,2

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan;

Department of Medicine, MacKay Medical College, New Taipei City, Taiwan¹;

Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan²

Background:

Foreign bodies in the kidney have rarely been reported. However, they can be a clinical problem for urologists. We report on a patient with a residual segment of guidewire coating embedded in the renal parenchyma following computed tomography (CT) guided percutaneous nephrostomy drainage (PCND), and our successful minimally invasive management with retrograde intrarenal surgery (RIRS).

Case presentation:

A 40-year-old female with urosepsis due to a right upper ureteral stone with hydronephrosis received emergent CT-guided PCND and subsequent ureteroscopic lithotripsy, double J stent insertion and percutaneous catheter removal. Follow-up radiography showed a coiled object within the upper pole parenchyma of the right kidney, which might be the remnant of a guidewire used during the PCND procedure.

Flexible ureteroscopy (fURS) was performed. Under fluoroscopy, the foreign body was localized, the renal parenchyma was incised with Holmium laser, and the foreign body was retrieved using a stone basket.

Conclusions:

Although guidewire breakage is uncommon, clinicians should keep it in mind during interventional procedures. Several methods can be used to eradicate foreign objects from the urinary tract, and the first choice should always be the least invasive one. RIRS with fURS is considered as a safe, efficient, and minimally invasive option for the extraction of foreign bodies from the kidney. To the best of our knowledge, this is the first comprehensive case report detailing the removal of a foreign object by RIRS in the English literature.