難治性全尿道狹窄之處置：PCNL氣囊擴張作為替代性治療策略

張有元、楊承翰、曹智惟、卓育慶

三軍總醫院 外科部 泌尿科

PCNL Balloon Dilatation as an Alternative Approach for Refractory Panurethral Stricture

Yu-Yuan Chang, Cheng-Han Yang, Chih-Wei Tsao, Yu-Cing Jhuo

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei 114, Taiwan

Abstract

Background: Panurethral stricture is a complex condition that may arise from repeated instrumentation, radiotherapy, chemotherapy, or immune-related inflammation. Immune checkpoint inhibitors have been reported to induce immune-mediated cystitis and ureteritis; however, their association with urethral stricture remains unclear.

Case presentation: A 56-year-old man with recurrent urothelial carcinoma received neoadjuvant chemotherapy, pelvic radiotherapy, and subsequent nivolumab. He later developed progressive panurethral stricture and presented with acute urinary retention and acute kidney injury. Initial internal urethrotomy achieved only transient improvement, and the stricture rapidly recurred with severe urethral fibrosis. As conventional urethrotomy was no longer feasible, we performed balloon dilatation using a PCNL dilator, which resulted in minimal bleeding and short hospitalization. Although the patient regained spontaneous voiding for several weeks, the stricture recurred, and suprapubic cystostomy was ultimately required.

Conclusion: This case highlights the difficulty in treating severe panurethral stricture after multimodal oncologic therapy. PCNL balloon dilatation may serve as a practical, low-morbidity alternative when endoscopic urethrotomy fails, offering temporary relief in selected patients. The potential relationship between immune checkpoint inhibitors and urethral fibrosis warrants further study.