腎臟切除後輸尿管皮膚瘻管病例報告
洪巨軒、蔡樹衛、羅華安
國泰綜合醫院 外科部 泌尿外科
A Ureterocutaneous Fistula after Nephrectomy
Chu-Hsuan Hung, Shu-Wei Tsai, Wah-On Lo
Division of Urology, Department of Surgery, Cathay General Hospital
Abstract: A ureterocutaneous fistula developed after nephrectomy is a rare disease. We could choose conservative treatment, subtrigonal injection under cystoscopy, or invasive surgery depending on the different situation of patients.
We report a case of a 70-year-old female presenting with intermittent discharge over left flank operating scar for several years. The semi-transparent discharge without odor usually occurred while micturition. The symptom progressed gradually within this year. She received left nephrectomy due to stone-related atrophic kidney about 40 years ago.
Physical examination revealed a little defect over the left flank operating scar without erythema or tenderness. Computed tomography (CT) showed a subcutaneous density in left flank skin wound extending to left lateral abdominal muscle. We injected contrast from the skin defect and the fistulography revealed the contrast opacification of left ureter draining into bladder smoothly. Thus, the diagnosis of left ureterocutaneous fistula is established. After discussion with patient and regarding the fair results of pre-operative evaluation, the surgery was considered.
We designed the surgery composed of three stages, including ureter catheter insertion, ureterectomy from the Gibson incision, and fistulectomy from the old scar. The surgery was performed smoothly. The pathology reported the ureter measuring 18.2 cm in length, with focal chronic inflammation. The post-operative course was smooth, and patient discharged at the fifth day after surgery.
Conclusion: There are many different managements of ureterocutaneous fistula developed after nephrectomy. We could choose the appropriate methods for the different conditions of patients. The surgery is one of the effective and safety choices.