多囊腎合併腎臟輸尿管結石的治療– 病例報告

徐則中¹、莊梓昱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

Stone intervention in Polycystic kidney disease patient– a case report

Tze-Jung Shiu¹, Tzu-Yu Chuang², Chang-Chi Chang², Yi-Chun Chiu²

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

Introduction: ADPKD is one of the most common inherited renal diseases, and it usually companied with urolithiasis. Clinical management of kidney stones in ADPKD patients is similar with that in general patients, but the optimal strategy is still uncertain. We present a case of ADPKD patient with stones, undergone lithotripsy.

Case presentation: A 49 year-old male patient with underlying disease of (1) Polycystic kidney disease (2) Hypertension (3) Urolithiasis. He had incidental finding of Polycystic kidney disease with bilateral urolithiasis, prominent 2 cm in left kidney and 1.1 cm in left ureter, and hydronephrosis found by abdominal CT on 2023/09/06. Physical examination presented left costovertebral angle mild knocking tenderness. Blood test showed no specific finding, and urine analysis showed microscopic hematuria. Then, we planned to perform 2-step surgery to deal with his urolithiasis to prevent too long surgery time and the risk of urosepsis. First, the patient underwent bilateral URSL and left 6Fr. 26cm double J stent insertion on 2023/11/14. Next, he experienced flexible RIRS on 2023/12/15. Afterward, the patient returned to GU OPD for follow-up.

Discussion: Laparoscopic ureterolithotomy(RPLU), FURL and PCNL are commonly used surgical methods to solve upper urinary calculi in ADPKD patients. These approaches could both achieve satisfactory stone clearance while FURL showed a higher safety.