透過經皮腎造口碎石手術同時處理雙側腎結石和大型上段輸尿管結石
-案例分享

徐易廷¹、黃建榮¹、李淑文¹、薛又仁^1,2、蕭毅君¹、賴昱維^1,2、邱文祥^1,2

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²國立陽明交通大學 醫學院 泌尿學科

Management of Bilateral Renal Stones and Large Upper ureteric Calculus by Percutaneous Nephrolithotomy Simultaneously- a case report

Yi-Ting Hsu¹, Andy. C. Huang¹, Carol S. Li¹, Thomas Y. Hsueh^1,2, Yi-Chun Hsiao¹, Yu-Wei Lai^1,2, Allen W. Chiu^1,2

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

²Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Background: Large stones in the upper ureter can be accessed with endoscopy via retrograde and antegrade approaches. Rigid ureteroscopy lithotripsy (URSL) and flexible ureteroscopy (RIRS) are the retrograde techniques while percutaneous nephrolithotomy (PCNL) is the antegrade approach. The challenge of selecting the optimal technique for the patient based on the stone's size and location persists. In the present case, we demonstrated the ease and success management of combined bilateral kidney stones and large upper ureteric stones with PCNL.

Case Presentation: A 49-year-old male patient presented to the urologic clinic with renal sonogram showed bilateral hydronephrosis. Abdominal computed tomography showed bilateral renal stones and bilateral upper ureteral stones with obstruction. Left PCNL was performed for a kidney stone around 3.0cm at lower calyx and an upper ureteric stone around 2.3cm, followed by right PCNL for several right kidney stones and an upper ureteric stone around 2.3cm. Operative time was 117 min with blood loss around 150mL. Both sides were managed with single puncture site. There was near-complete resolution of the calculus and the patient was discharged on post operation day three. In our experience, PCNL can be done successfully in treating upper ureteric stones combined with kidney stones. It was easy to access and break the stone when it is at a fixed site.

Conclusions: The management of a large upper ureteric calculus through PCNL can be carried out safely and effectively. This approach is known for its swiftness and  favorable stone clearance rates.