Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, Japan.
Urolithiasis. 2019 Oct;47(5):467-471. doi: 10.1007/s00240-019-01153-x. Epub 2019 Aug 9.
We present the case of a 46-year-old man who underwent successful antegrade ureteroscopy for lithiasis in his allograft ureter. At a scheduled follow-up 15 years after transplantation, computed tomography (CT) detected a 12-mm renal stone in the renal pelvis of the transplanted kidney. During his follow-up, gross hematuria was seen; the stone moved to the ureter, causing hydronephrosis. Ultrasound and non-contrast CT revealed hydronephrosis and a 15-mm stone in the transplanted ureter. Considering the stone size, location, and the difficulty of the access to the anastomosed ureteral orifice, percutaneous ureteroscopic approach was planned. Due to the anatomical difficulty regarding his allograft kidney, we planned to prepare a 3D image and model for selecting the best percutaneous approach. The procedure was performed and a stone-free status was acquired without complication. Under precise simulation, we performed successful antegrade ureteroscopy for lithiasis in the allograft ureter supported by 3D imaging. Use of a 3D printed model may aid in a safe and effective procedure for lithiasis in the allograft kidney and ureter.
我们报告了 1 例 46 岁男性患者,他曾因同种异体输尿管结石成功接受顺行输尿管镜检查。移植后 15 年的定期随访中,计算机断层扫描(CT)发现移植肾肾盂内有 12mm 肾结石。在随访过程中,患者出现肉眼血尿,结石移动至输尿管,导致肾积水。超声和非增强 CT 显示移植输尿管存在肾积水和 15mm 结石。考虑到结石大小、位置以及吻合口输尿管进入的难度,计划行经皮输尿管镜取石术。由于同种异体肾的解剖学困难,我们计划准备 3D 图像和模型以选择最佳的经皮入路。该手术顺利进行,无并发症,结石完全清除。在精确模拟下,我们成功地为同种异体输尿管结石患者进行了顺行输尿管镜检查,该患者得到了 3D 成像的支持。3D 打印模型的使用可能有助于同种异体肾结石和输尿管结石的安全、有效治疗。