大量結石以藥物完治
李玉瀚、陳昱廷、蔡翰宇、曹書瀚、侯鎮邦、林友翔、陳建綸

林口長庚醫院 外科部 泌尿科

Medical resolution of large stone burden– A case report

Yu-Han Li, Yu-Ting Chen, Han-Yu Tsai, Shu-Han Tsao, Chen-Pang Hou,

Yu-Hsiang Lin, Chien-Lun Chen

Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital

Introduction

Uric acid stones account for 10 percent of urinary tract stones. Patients with hyperuricemia and acidic urine pH are clues of uric acid stone. Plain radiography is likely to miss the detection of uric acid stones because pure uric acid stones are radiolucent, but they are seen by CT scan.

Case presentation:

A 67-year-old male was referred from local hospital for hematuria and the CT scan reporting bilateral renal stones, right 4.2 cm and left 3.3cm (Figure1). He denied past history of diabetes or hypertension. He had regular coumadin medication for atrial fibrillation and arrhythmia. Renal echo revealed bilateral staghorn stone and right renal cyst 5.8cm without hydronephrosis. After medication, the follow-up CT scan 8 months later showed nearly stone free without any surgical intervention (Figure 2).

Conclusion

The most common etiology of uric acid stones is idiopathic other than acquired or secondary such as hyperuricemia or dietary factors. The idiopathic etiology is associated with metabolic disorder, including aciduria, diabetes mellitus, metabolic syndrome, and obesity. Alkalinization of urine can result in dissolution of non-obstructing pure uric acid stones. Therefore, more invasive procedures are usually not required. However, the patient may need surgical intervention if acute kidney injury, obstructive nephropathy, severe urinary tract infection or failure of medicine treatment is noted.