雙側輸尿管結石延誤處理之後續發展

唐慈翊^1-3、曹曜軒¹

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

Delayed Management of Bilateral Ureteropelvic Junction Stone Impaction

Tsz-Yi Tang^1-3, Yau-Hsuan Tsau¹

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 40-year-old male foreign laborer presented to the emergency department (ED) after experiencing bilateral flank pain for several weeks, which had become intolerable during his day off. Physical examination showed bilateral costovertebral angle tenderness. An initial ultrasound examination revealed severe hydronephrosis, and laboratory tests showed white blood cell (WBC) count 7710/ul (segmented neutrophils 77.8%), C-reactive protein (CRP) 2.64 mg/L, hemoglobin 6.8 g/dL, blood urea nitrogen (BUN) 117 mg/dL, creatinine 19.44 mg/dL, hyponatremia (sodium, Na=131 mmol/L), hypokalemia (potassium, K = 3.1 mmol/L), metabolic acidosis (pH 7.061, bicarbonate 5.5 mmol/L), and hypercalcemia (ionized calcium 1.89 mg/dL). Abdominal computed tomography confirmed bilateral hydronephrosis, grade IV, and bilateral ureteropelvic junctional stone impaction around 0.8-0.9 cm, with thin renal cortex (Figure 1-2). Urgent bilateral percutaneous nephrostomy (PCN) insertion was performed. Four days post-PCN insertion, follow-up laboratory results showed a decrease in creatinine levels to 11.96 mg/dL.

Bilateral flank pain may indicate ureteral stones causing obstruction, risking chronic kidney disease or dialysis if untreated. The patient's delayed medical visit due to work emphasizes the need for quick medical care. Early ultrasound and ureteral stone treatment are vital to avoid complications and renal damage, even though renal function might not fully recover post-intervention.

Conclusion:

Bilateral ureteral stone impaction can lead to severe renal damage and associated complications, including acidosis and anemia. Therefore, even if the pain from bilateral ureteral stones is bearable or the stones are small, proactive management is essential to prevent the progression of hydronephrosis and avoid renal parenchyma injury.