特發性的後腹腔纖維化合併輸尿管阻塞的治療 – 病例報告

徐則中¹、黃建勳²、張彰琦²、邱逸淳²

臺北市立聯合醫院仁愛院區¹、忠孝院區²  外科部 泌尿科

Treatment of Idiopathic retroperitoneal fibrosis with ureteral obstruction– a case report

Tze-Jung Shiu¹, Ken-J. C.H. Huang ², Chang-Chi Chang², Yi-Chun Chiu²

Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch¹, Zhongxiao Branch², Taipei, Taiwan

Introduction: Secondary retroperitoneal fibrosis(RPF) is associated with malignant disease, drugs, exposure to radiation and surgery. In contrast, the majority of RPF is classified into idiopathic retroperitoneal fibrosis. And it may cause ureteral obstruction.

Case presentation: A 83-year-old man with underlying disease of (1) Bronchiectasis over LLL ( 2) Chronic kidney disease stage 3  (3) Hypertension (4) Benign Prostatic Hyperplasia (5) Urolithiasis (6) Intermittent high degree AV block, s/p permanent pacemaker implantation (DDD, 1.5T MRI compatible, LB pacing). He complained right flank pain since 2023/10/17, but he denied dysuria, hematuria, or fever. Physical examination presented soft abdomen with right CV angle knocking tenderness noted. KUB showed right urolithiasis. Abdomen CT showed right upper third ureteral stone with obstructive uropathy. Blood test showed creatinine 1.8 mg/dL, but no leukocytosis. Urine analysis showed hematuria and pyuria. After discussion, he underwent right URS on 2023/10/19. However, right upper third ureteral tortuosity was noted and failed to inspect renal pelvis. Then, we consulted Radiologist for PCN and DBJ insertion on 2023/10/20. Then, he was discharged on 2023/10/25.

    Afterward, he received ESWL twice, but stones didn’t pass. KUB showed right ureteral stone and right tortuous ureter stent. Therefore, he was admitted for right laparoscopic retroperitoneal ureterolysis and URSL, performed on 112/12/15. After the surgery, KUB showed that the tortuous ureter had been corrected. Afterward, the patient returned to GU OPD for follow-up.

Discussion: There is no optimal treatment for RPF. The most important reason for this issue is the limited number of patients in the literature. Ureteral catheters or PCN could provide temporary solutions of urinary obstruction; on the contrary, ureterolysis is a permanent way and can preserve renal function. Ureterolysis seems to be safe and its success rate can reached 84.1 – 90%.