個案報告：輸尿管金屬支架阻塞感染導致腎臟破裂以及支架跑位

蔡宏偉¹ 、許炯明 ¹

¹台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院泌尿科

Obstructive metallic stent with infection causing renal rupture and stent migration: a case report

Hung Wei Tsai¹、Chiung Ming Hsu ¹

¹Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan

Introduction:

In adults, intermittent abdominal or flank pain, at times associated with nausea or vomiting, is a frequent presenting symptom. Hematuria, either spontaneous or associated with otherwise relatively minor trauma, may also be an initial symptom of obstruction of upper urinary tract. Management must be made if severe symptoms or infection presented.

Case description:

This 61-year-old male with history of left upper ureteral stricture s/p Laser endoscopic ureterotomy + Metallic stent placement in 2024/06. This time, he visited ER presented with high fever and left flank pain for one day. Lab data showed WBC:11200 /uL, CRP:12 mg/dL and Creatinine: 1.0mg/dL. KUB reported left renal stones and metallic left ureteral stent encrustation in upper end. Abdominal CT was arranged for further evaluation and revealed Left hydronephrosis and hydroureter + A metallic stent in left ureter with encrustation in proximal tip. And we consulted Radiologist for Left PCN insertion on the next day. However, pre-renal hematoma and renal rupture was noted during pre-PCN CT evaluation. Left PCN insertion was postponed, so the patient was admitted to ordinary ward and continuous antibiotic treatment for one week. Unfortunately, his fever did not subside, and URS + DJ insertion was arranged. Left URS revealed very turbid and bloody urine coming from left kidney. About 500ml urine was drained under URS. A DJ stent was placed. Metallic stent cloud not be seen due to poor visual field intra-operatively. Surprisingly, post-operative KUB found an upper migrated metallic stent in left upper ureter with stone encrustation migrated into left renal pelvis and calyx. His condition was getting better and was discharged five days after DJ placement. Left nephrectomy was discussed with the patient and may be arranged in coming month.

Discussion and Summary:

Expandable metallic mesh stents that allow tissue ingrowth have proven to have problems with encrustation, hyperplastic reactions, and tumor ingrowth [1]. Recently, systematic reviews of the literature confer that metallic stents are a viable alternative for both malignant and benign ureteral obstruction with a mean success rate of 72.5% and a low migration rate (1%) [2][3]. For ureteral stricture disease, treatments such as Ureteral stent placement, Balloon dilatation, Endoureterotomy or Reconstructive repair may all be considered for any circumstances.