人工膀胱巨大結石 案例報告

蔡政諭 余家政

高雄榮民總醫院外科部泌尿外科

Jeng-Yu Tsai, Chia-Cheng Yu

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital

 

Patient, a 62-year-old man, underwent radical cystectomy with modify Camey neobladder due to muscle invasion bladder urothelium carcinoma at 2002. One vesical stone was noted one year after the operation. He refused stone treatment and lost follow up since then.

He was admitted to our nephrology ward due to influenza A, acute renal failure and urinary tract infection at last Aug. Huge vesical stones and bilateral ureter stones with bilateral hydronephrosis were noted from CT scan. The maximum stone burden was 280 cc and 80 cc respectively. After bilateral PCND and infection under control, patient was re-admitted to our ward for lithotripsy. Vesical stones were treated by nephroscopic via urethra using ultrasonic or laser lithotripsy in 6 sessions. Stone fragments were removed by water flow rather than Toomy irrigation. After vesical stones were removed successfully, ureteroscopic lithotripsy were done to treat ureter stone over both side. Now patient was stone free with bilateral double J stent.

For such huge vesical stone treatment, nephroscopic ultrasonic lithotripsy was more efficiency than Ho-Yag laser lithotripsy. Stone fragment wash out using water flow without Toomy provide effective stone removal in neobladder without perforation or trauma.