Sekhon Virender, Suryavanshi Manav
Section of Paediatric Urology, Division of Urology, Renal Transplant and Robotics, Medanta-The Medicity, Gurgaon, India.
Section of Endourology, Division of Urology, Renal Transplant and Robotics, Medanta-The Medicity, Gurgaon, India.
J Endourol Case Rep. 2017 Jun 1;3(1):78-80. doi: 10.1089/cren.2017.0040. eCollection 2017.
Gunshot injury of ureter is common, but isolated injury of pelvi-ureteric junction (PUJ) has not been reported. Moreover, its management is evolving from the traditional urinary diversion, stenting followed later by definitive surgical repair to a more upfront minimally invasive endourologic approach. An adolescent boy presented with gunshot laceration injury of left PUJ with associated small intestinal injury. Radiological investigations confirmed a contained urinary leak. Retrograde stenting was not effective. The same guidewire was retained into the urinoma and an antegrade percutaneous access was obtained. A snare was used to retrieve the guidewire and obtain a through and through access. A ureteropelvic drainage catheter was inserted over this guidewire and secured in the upper ureter, bypassing the region of injury. Three weeks later, the drainage tube was removed and the same tract was used for antegrade stenting. A retrograde pyelogram done 3 months later during stent removal demonstrated no leak. The patient is asymptomatic for urinary symptoms on 6 months of follow-up. Rendezvous technique is a feasible alternative to open repair of gunshot pelvi-ureteric junction injury. Long-term follow-up is awaited.
输尿管枪伤很常见，但肾盂输尿管连接处（PUJ）的孤立伤尚未见报道。此外，其治疗方法正在从传统的尿流改道、先置入支架随后进行确定性手术修复，演变为更直接的微创腔内泌尿外科方法。一名青春期男孩因左PUJ枪伤撕裂并伴有小肠损伤前来就诊。影像学检查证实存在局限性尿漏。逆行置入支架无效。将同一导丝留置在尿瘤内，并获得顺行经皮穿刺通路。使用圈套器取出导丝并获得贯通通路。在该导丝上插入输尿管肾盂引流导管并固定于上段输尿管，绕过损伤区域。三周后，拔除引流管，利用同一通道进行顺行支架置入。三个月后在取出支架时进行的逆行肾盂造影显示无漏尿。随访6个月时，患者无泌尿系统症状。会师技术是治疗枪伤性肾盂输尿管连接处损伤开放修复的一种可行替代方法。有待进行长期随访。
