Jouini Riadh, Maazoun Kaies, Sahnoun Lassaad, Mekki Mongi, Belghith Mohsen, Nouri Abdellatif
Service de Chirurgie Pédiatrique, Hôpital Fattouma Bourguiba, Monastir, Tunisie.
Prog Urol. 2005 Jun;15(3):505-10.
Ureteric stones are generally solitary and less than 2 cm long. Exceptionally, ureteric stones can be longer than 5 cm and/or weigh more than 50 grams, and are referred to as giant ureteric stones. In the light of two personal cases and a review of the literature, the authors review the epidemiological, aetiopathogenic, clinical and therapeutic aspects of this disease with particular emphasis on the importance of the aetiological work-up. These two cases concerned two boys, aged 10 years and 4 and a half years, respectively, with no particular medical history, who presented an acute episode of pyelonephritis. The KUB plain film, renal ultrasound and IVU demonstrated a huge stone filling the right ureter in one case and the left ureter in the other case. The stones were treated surgically in both cases. The aetiopathogenesis of these large ureteric stones remains unclear. A urinary tract malformation (megaureter, ureterocele, stricture, etc.), either alone or associated with a metabolic predisposition plays an important role in the pathogenesis of these large stones. The aetiological work-up of these large stones is essential. Morpho-constitutional stone analysis provides extremely useful and even decisive information in some cases for the aetiological diagnosis. Despite the development of extracorporeal lithotripsy and endourological techniques, the treatment of giant ureteric stones often remains surgical.
输尿管结石通常为单发,长度小于2厘米。极少数情况下,输尿管结石可超过5厘米长和(或)重量超过50克,被称为巨大输尿管结石。结合两例个人病例并复习文献,作者回顾了该病的流行病学、病因病理、临床及治疗方面,特别强调了病因学检查的重要性。这两例病例分别涉及一名10岁男孩和一名4岁半男孩,他们均无特殊病史,均出现了肾盂肾炎急性发作。腹部平片、肾脏超声和静脉肾盂造影显示,一例右侧输尿管被巨大结石充盈,另一例左侧输尿管被巨大结石充盈。两例均接受了手术治疗。这些巨大输尿管结石的病因病理仍不清楚。尿路畸形(巨输尿管、输尿管囊肿、狭窄等),单独存在或与代谢易感性相关,在这些巨大结石的发病机制中起重要作用。对这些巨大结石进行病因学检查至关重要。形态结构结石分析在某些情况下为病因诊断提供了极其有用甚至决定性的信息。尽管体外冲击波碎石术和腔内泌尿外科技术有所发展,但巨大输尿管结石的治疗往往仍需手术治疗。