攝護腺癌放射治療後自發性輸尿管破裂-案例報告
劉家翔1、吳宏豪1,2,3、林登龍1,2,3、陳光國1,2,3
1臺北榮民總醫院 泌尿部2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Spontaneous ureteral rupture in prostate cancer post-radiation therapy
Chia-Hsiang Liu1, Howard H.H Wu1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei , Taiwan; 2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Shu-Tien Urological Science Research Center , Taipei, Taiwan
Introduction:
Rupture of ureter, although uncommon, can result from external trauma, surgical injury, ureteral instrumentation,or ureteral obstruction by a calculus or tumor. Extravasation of urine secondary to rupture of the ureter in the absence of any demonstrable cause has been named “spontaneous rupture of the ureter” . Perforation could occur at any level from the calix to the bladder but it is usually seen at the fornices and upper ureter. We present a rare case of spontaneous perforation of the ureter at middle third caused by ureteral stone in a metastatic prostate cancer post-radiation therapy.
Case:
81-year-old male has metastatic prostate cancer status post radiation therapy. He suffered from acute onset of sevee pain over left lower abdomen and visited ED. Blood routine data showed acute kidney injury (Creatinine from 1.14 to 2.12) without infection sign. Urine routine showed microscopic hematuria (RBC 3+/HP, WBC 0-2/HP). Abdominal computed tomography (CT) showed a 0.4 cm left upper third ureteral stone with suspicion of ureteral rupture. Ureterorenoscopy and retrograde pyelography revealed middle third ureteral rupture and contrast extravasation. Contrast enhanced pelvic computed tomography(CT) showed fluid accumulation with contrast pooling and gas bubble retention , fat stranding, and fascial thickening in left perirenal space, retromesenteric plane, and retrorenal plane. Antegrade pyelographyrevealed left ureteral rupture with urinoma formation at the middle third of left ureter and percutaneous nephrostomy with antegrade double J stenting was applied.
Conclusion:
Spontaneous rupture of the ureter is a very rare condition and usually results from ureteral obstruction by a calculus. Prostate cancer post-radiation therapy can lead to ureteral stricture, which can also be a threat to spontaneous ureteral rupture. Spontaneous ureteral rupture should be kept in the differential diagnosis of patients with acute abdominal or flank pain in the emergency department.