逆行性腎臟內手術治療巨大腎盂旁囊腫:案例報告

陳建凱、石宏仁

彰化基督教醫院 外科部 泌尿科

Retrograde intrarenal surgery for a giant para-pelvic cyst: a case report

Jian-Kai Chen, Hung-Jen Shih

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction: Simple renal cyst is the most common cystic lesion of the kidney. It is always asymptomatic; however, it could result in significant symptoms when its size get huge. Here, we present a patient who received the treatment of retrograde intrarenal incision for para-pelvic cyst.

Case report: The patient is a 59-year-old married taiwanese woman, without any past history, who present with right flank soreness for several months. This patient suffered from the above episode and came to urology outpatient department for help. Neither nausea nor vomiting was encountered this time. Physical examination revealed mild knocking pain over right flank region. Right acute pyelonephritis was noted 1 month ago. Arranged computed tomography on 2023-06-20 showed right pararenal cyst with hydronephrosis and double-J stent in situ. Urinalysis was done on 2023-06-25, which showed hematuria and pyuria with bacteria presenting. Urine culture showed Klebsiella pneumoniae. Then, the patient was admitted due to right para-pelvic cyst with hydronephrosis and urinary tract infection. The operation of retrograde intrarenal surgery with incision of right renal cyst with thulium laser accompanied with double-J stent insertion was performed smoothly on 2023-06-26. During the operation, large right para-pelvic renal cyst was found; the cyst wall about 2x2 cm was removed with thulium laser and there was no visualized mass lesion inside the cyst. After one day monitoring, the general condition was stable and good. Checking with bedside echo showed complete drainage of fluid after incision of cyst. Thus, the Foley's catheter was removed and dischargement was arranged one day after surgery.

Conclusions: We successfully treated giant para-pelvic cyst by retrograde intrarenal surgery with laser fulguration, no complications were encountered. RIRS can be performed effectively and safely for giant para-pelvic cyst in selected patient.