經皮順行性軟式輸尿管鏡同時治療迴腸導管病患之輸尿管結石與吻合處狹窄：病例報告

許智凱、張廷瑞、陳世亮

台南市立醫院 泌尿科

Simultaneous Anterograde Flexible Ureteroscopic Management of Ureteral Stone and Uretero-Ileal Anastomotic Stricture in a Patient with Ileal Conduit: A Case Report

Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

Introduction: Uretero-ileal anastomotic stricture (UIAS) and urolithiasis are known complications following radical cystectomy with ileal conduit urinary diversion. Management of these complications is challenging; the retrograde endoscopic approach is often difficult due to the tortuosity of the conduit and inability to locate the ureteral orifice. We present a case where a percutaneous anterograde approach using a flexible ureteroscope was successfully employed to treat both a mid-ureteral stone and an anastomotic stricture in a single session.

Case Report: A 72-year-old male with a history of diabetes, coronary artery disease, chronic kidney disease, and gout presented with acute pyelonephritis and hydronephrosis. He had undergone radical cystectomy with an ileal conduit six years prior for bladder cancer and had a history of recurrent urolithiasis treated with ESWL. Imaging revealed a stone impacted in the mid-ureter and a suspected stricture at the uretero-ileal anastomosis. Due to the anatomical complexity, an anterograde approach was selected. Percutaneous renal access was established, and a 14-Fr Amplatz sheath was placed. A flexible ureteroscope was introduced anterogradely through the sheath. The mid-ureteral stone was fragmented using laser lithotripsy. Further navigation revealed a significant stricture at the uretero-ileal anastomosis. A guidewire was successfully passed through the stricture, followed by balloon dilation. A double-J stent was placed antegrade. The stent was removed three months post-operatively. At the two-year follow-up, the patient remained symptom-free with no radiological evidence of stricture recurrence.

Discussion: This case demonstrates the utility of the anterograde approach for managing complex upper tract pathology in patients with urinary diversion. The use of a 14-Fr Amplatz sheath provided stable access for the flexible ureteroscope, allowing for precise stone management and effective balloon dilation of the stricture. This technique offers a safe and feasible alternative when retrograde access is technically impossible or has failed, providing durable long-term patency.