逆行性腎臟內鏡手術意外發現腎盂腫瘤：綜合治療方法的病例報告

唐慈翊^1,2、李永進^1,2,3

高雄市立小港醫院¹泌尿科

高雄醫學大學附設醫院²泌尿科

 高雄醫學大學醫學院³泌尿學科

 Incidental Discovery of Renal Pelvic Tumor During Bilateral Retrograde Intrarenal Surgery (RIRS):
A Case Report with Integrated Approach

Tsz-Yi Tang^1,2, Yung-Chin Lee^1,2

¹Department of Urology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

³Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan

Case report

A 67-year-old male with no pre-existing conditions was admitted for management of bilateral renal stones. Preoperative computed tomography (CT) was conducted and revealed bilateral renal stones without any tumor presence. Bilateral retrograde intrarenal surgery (RIRS) was performed, during which an unanticipated tumor in the left renal pelvis was discovered (Figure 1). Pathological results confirmed the diagnosis of noninvasive papillary urothelial carcinoma, high grade. Subsequently, left endoscopic laser tumor ablation was executed on January 5, 2023.

Initially, the patient declined nephrectomy. A regular follow-up regimen was established, consisting of flexible ureteroscopy and cystoscopy every three months to monitor for tumor recurrence and other potential complications. After 3 months, a follow-up cystoscopy revealed a bladder tumor. Thus, another left RIRS and transurethral resection of the bladder tumor (TURBT) were performed. No tumors were found in the left renal pelvis and ureter, and the washing cytology was negative for malignancy. Pathology of the bladder tumor indicated noninvasive papillary urothelial carcinoma, low grade. After that, a 3-month follow-up left RIRS showed no recurrent bladder tumor. CT imaging indicated mild thickening and dilatation of the bilateral urinary collecting systems, raising concerns for chronic ureteritis, pyelitis, or subtle tumor presence. Washing cytology showed negative findings.

Conclusion: