「消失的結石」：一例開口於前列腺尿道之異位輸尿管結石病例報告及文獻回顧

陳穎政^1、2、顏敬恒³

國防醫學大學三軍總醫院 外科部 泌尿外科¹ ;國軍桃園總醫院 外科部 泌尿外科² ;國防醫學大學三軍總醫院松山分院 外科部 泌尿外科³

“Missing stone” in an ectopic ureter inserting into the prostatic urethra: A case report and review of literature

Ying-Zheng, Chen^1、2、Ching-Heng, Yen³

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan¹; Division of Urology, Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan , Taiwan²; Division of Urology, Department of Surgery, Tri-Service General Hospital SongShan Branch, National Defense Medical University, Taipei, Taiwan³

Purpose:

Ureteral duplication is a relatively common congenital anomaly of the urinary tract; however, ureteral calculi occurring within a completely duplicated system are uncommon. Stones located in an ectopic ureter inserting into the prostatic urethra are particularly rare and may present significant diagnostic challenges.

Case Presentation:

We report the case of a 39-year-old man who presented with several weeks of left-sided flank colic without fever. Initial non-contrast computed tomography demonstrated a distal left ureteral calculus. However, ureteroscopy failed to identify the stone, and retrograde pyelography suggested an anomalous ureteral course. Subsequent intravenous pyelography confirmed a duplicated collecting system with an ectopic ureter inserting below the bladder neck and associated mild hydroureteronephrosis. Repeat ureteroscopy identified the ectopic ureteral orifice within the prostatic urethra near the verumontanum, and the stone was successfully treated with laser lithotripsy.

Conclusion:

This case highlights the importance of considering ureteral duplication with ectopic insertion when operative findings do not correlate with preoperative imaging. Pyelography and careful cystoscopic inspection remain essential diagnostic tools in such cases, and ureteroscopy with laser lithotripsy is an effective treatment for ectopic ureteral calculi.