泌尿道類澱粉蛋白沉積症之台中榮總經驗分享
梅承恩、廖博崎、裘坤元、賀昊中、陳卷書、程千里、李建儀、王賢祥、楊晨洸、陳正哲
臺中榮總外科部泌尿外科
Urinary tract amyloidosis - experience of VGHTC
Cheng-En Mei, Po-Chi Liao, Kun-Yuan Chiu, Hao-Chung Ho, Chuan-Shu Chen, Chi-Feng Hung, Chen-Li Cheng, Jian-Ri Li, Shian-Shiang Wang, Cheng-Kuang Yang, Cheng-Che Chen
Division of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: Urinary tract amyloidosis is a rare condition. Its clinical presentation is similar to malignancy of urinary tract. It is important for clinicians to recognize this condition.
Materials and Methods: We collect patients diagnosed as localized amyloidosis of the renal pelvis, ureters, urinary bladder, or urethra from 2000 to 2015. Initial presentation, image findings, treatment and outcome were analyzed.
Results: Six localized amyloidosis are identified. Among them, two of them are originated from urinary bladder and four from renal pelvis and ureter. None of our cases showed evidence of systemic amyloidosis. Painless gross hematuria is the most frequent symptom of localized amyloidosis of the urinary tract. Patients with bladder involvement were treated with localized bladder resection; those with renal pelvis and ureter involvement, three underwent ureteroscopic resection and one received percutaneous nephroscopic resection. After surgical resection, no complications were noted in patients with bladder involvement. Of patients with ureter and renal pelvis involvement, one require long-term double-J exchange for persisted obstructive uropathy; two developed permanent decrease of renal function; one had improved renal function.
Conclusions: Localized amyloidosis of the urinary tract is a rare condition that mimicking malignancy of the urinary tracts. Some might reveal hydronephrosis and had decreasing renal function. To pathologic diagnosis of amyloidosis of the urinary tract, Congo red stain is essential. The treatment is usually conservative with observation or surgical resection with long-term follow up. Amyloidosis of renal pelvis and ureter cause more severe consequences than those with bladder involvement.