Prakash Jai, Raj Anubhav, Sankhwar Satyanarayan, Singh Vishwajeet
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
BMJ Case Rep. 2013 Mar 26;2013:bcr2013008889. doi: 10.1136/bcr-2013-008889.
A 60-year-old woman presented with complaints of intermittent right flank pain which had begun one year ago. Ultrasonography and intravenous urogram showed right pelvic (15 mm) and inferior calyceal (6 mm) calculi along with suspected retrocaval course of right ureter, which was confirmed by contrast CT scan. Tc-99m diethylene-triamine-penta-acetic acid (DTPA) scan showed normal function and normal drainage of right kidney. Percutaneous nephrolithotomy (PCNL) was performed for right renal calculi. Because of curved ureteric course, negotiation of ureteric catheter in pelvis was anticipated to be troublesome, so intraoperative retrograde pyelogram (RGP) was performed to delineate the anatomy. Puncture was performed safely after air contrast pyelography. No complications occurred intraoperatively and postoperatively. On follow-up of up to 1 year patient was asymptomatic and renal scan showed normal function and drainage. So in the presence of retrocaval ureter and associated renal calculi, PCNL is a safe and optimal procedure and in condition of non-obstructive drainage, management of calculi only is adequate.
一名60岁女性因间歇性右侧腰痛前来就诊，症状始于一年前。超声检查和静脉肾盂造影显示右侧盆腔有15毫米结石及下肾盏有6毫米结石，同时怀疑右侧输尿管走行于下腔静脉后方，对比CT扫描证实了这一情况。锝-99m二乙三胺五乙酸（DTPA）扫描显示右肾功能及引流正常。对右肾结石进行了经皮肾镜取石术（PCNL）。由于输尿管走行弯曲，预计在盆腔置入输尿管导管会很困难，因此术中进行了逆行肾盂造影（RGP）以明确解剖结构。在空气对比肾盂造影后安全地进行了穿刺。术中及术后均未发生并发症。随访长达1年，患者无症状，肾脏扫描显示功能及引流正常。因此，对于存在下腔静脉后输尿管及相关肾结石的情况，PCNL是一种安全且最佳的手术方式，在无梗阻性引流的情况下，仅处理结石即可。
