同時使用輸尿管導管及導尿管加速恢復腎臟部分切除術後之腎盂尿液漏出併發症

¹張德撝、²黃建榮

1台北市立聯合醫院忠孝院區泌尿科;²台北市立聯合醫院仁愛院區泌尿科

Concomitant usage of ureter and urethra catheters facilitate overcoming post partial nephrectomy urine leakage

¹Te-Wei Chang、²Andy C. Huang

¹Division of Urology, Department of Surgery, ZhongXiao Branch, Taipei City Hospital；

² Division of Urology, Department of Surgery, Renai Branch, Taipei City Hospital

Introduction:

Robot-assisted or laparoscopic partial nephrectomy (PN) plays an important role in managing small renal tumors. However, urine leakage (UL) is one of critical issues in postoperative complications. We shared our experience in managing UL with concomitant usage of ureter and urethra catheters to facilitate overcoming postoperative urine leakage successfully.

Case Presentation:

A 62-year-old male visited our urologic clinic because a 2 cm right renal mass was diagnosed incidentally on physical checkup. He denied any remarkable surgical history or underlying disease, including benign prostate enlargement. Series of examination including abdominal ultrasonography, abdominal computed tomography (CT) were performed. A renal tumor measured 2 cm in diameter with heterogenous content was impressed and malignancy cannot be ruled out. Hence, he undergone laparoscopic partial nephrectomy in our hospital. The hospitalization course was smooth, and patient discharged on day 7. Unfortunately, the patient visited our emergency room 1 week later due to fever and abdominal fullness. Abdominal CT revealed fluid accumulation in retroperitoneal space. A percutaneous pigtail drainage, double J tube and Foley catheter were placed immediately. During the hospitalization, an interesting phenomenon was observed. Once the urethral catheter was removed due to pigtail drainage dryness, the fluid leak from pigtail was noted again. Nevertheless, the pigtail drainage would keep dry if under the urethral catheter usage. Hence the urethral catheter was re-indwelled and avoid removal. After 30 days, the pigtail tube was dry and then removed. The patient was discharged with the urethral catheter. After another 30 days, urethra catheter was removed successfully without evidence of urine leakage again.

Discussion:

This is a case of UL after PN. The standard management of UL after PN includes prolonged drainage, retrograde ureter stent placement, percutaneous nephrostomy tube insertion, and surgical intervention. Percutaneous drainage tube, ureter stent and urethral catheter were placed in our case since initial identification of UL. However, increased amount of drainage from percutaneous drainage was noted after removal of urethral catheter. As the ureter stent can drain urine into bladder, the anti-reflux mechanism of the ureterovesical junction was temporarily disrupted by the ureter stent, which might result in poor healing process of renal parenchymal due to urine reflux. Therefore, we suggest concomitant usage of ureter and urethra catheters after PN to prevent urinary reflux and facilitate healing process of renal parenchyma, which might be helpful to manage UL after PN.