雙側完全型雙套輸尿管併結石：罕見案例報告
林冠榮1、黃子豪1,2,3、林登龍1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科2書田泌尿科學研究中心3
Bilateral complete duplication with ureteral urolithiasis and obstructive uropathy:
A case report and literature review
Kuan-Jung Lin1, Tzu-Hao Huang1,2,3, Alex Tong-Long Lin1,2,3
Department of Urology, Taipei Veterans General Hospital1; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Introduction:
Duplication of the ureters is the most common anomaly of the urinary tract, with an incidence of 0.7~4%. Patients with ureteral duplication may be complicated with urinary stones, ureterocele, VUR and obstructive uropathy. Duplications may be found in childhood or, less frequently, in later life, or they may be occult and discovered at autopsy. We present a rare case with bilateral duplication with ureteral urolithiasis and obstructive uropathy.
Case presentation:
A 43years-old man without underlying disease presented to our ER with progressive shortness of breath within two weeks. On presentation, his body temperature was 36 degree Celsius, blood pressure 213/143 mmHg, pulse rate 106 bpm, respiratory rate 16 bpm. Blood analysis showed high serum BUN (134 mg/dl), high serum creatinine (13.41 mg/dl), high NT-pro-BNP (99396.0 pg/mL), hypokalemia (3 0. mEq/l), anemia (9.5 g/dl). Blood gas analysis showed desaturation (81.5%) without acidosis and hypercapnia. Abdominal computed tomography showed bilateral ureteral stones with chronic obstructive uropathy and complete duplication of the left collecting system, with obstructive uropathy in both upper and lower moiety ureters. Emergent hemodialysis was done at first due to acute on chronic kidney injury and acute heart failure. After general condition got better, bilateral URSL for bilateral ureter of lower moiety were done. Ectopic ureter orifice of right upper moiety was found at bladder neck but the ureter was too tortuosto reach the ureteral stone.The ectopic ureter orifice of left upper moiety was found after transurethral resection of left base of the prostate. Multiple ureteral stones were found after TUR of prostate.
Conclusion:
Bilateral complete duplication of the ureters is a rare condition. Clinicians should be aware about anomalies of the urinary system prior to the surgical management of urinary stones, such as complete ureteral duplication.