Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2020 Oct;144:266. doi: 10.1016/j.urology.2020.06.027. Epub 2020 Jul 1.
Large ureteral stone burden can present significant challenges for the urologist to treat. Here we present the retrograde use of the Lithoclast Select, in a dilated distal ureter after incision of a ureterocele.
The patient is a 64 year-old female with large distal ureteral stone burden, with approximately 15 1-2 cm stones. She presented with significant right flank pain, urinary urgency, frequency, dysuria, and recurrent urinary tract infections.
A 22-French rigid cystoscope was inserted into the bladder. Urethral outlet was normal. Patient was noted to have 2 right-sided ureteral orifices, consistent with a completely duplex system. At the medial right ureteral orifice a very large ureterocele was noted. The lower pole system was scoped and stone free. The ureter to the upper pole moiety was scoped and a large stone burden within the distal ureter was visualized. The Plasmacise Gyrus was used to incise the anterior part of the ureter by inserting the Plasmacise into the ureteral orifice and tenting it anteriorly. The 24-French nephroscope was then inserted into the distal ureter. Graspers were used to extract many fragments however several were unable to be extracted from the distal ureter due to their size and thus were fragmented and evacuated with the ultrasonic lithoclast within the distal ureter. A 365-µ laser fiber was also used to fragment some of the stones. There were no complications. CT Scan 4 months post operatively was negative for stone recurrence. Last follow up was 15 months postprocedure where the patient was doing well.
Utilization of the rigid nephroscope and ultrasonic lithotripter in a female patient with a dilated distal ureter with a capacious or incised ureterocele is safe and effective, allowing for treatment of greater than 15 cm total distal ureteral stone burden.
大量输尿管结石会给泌尿科医生的治疗带来很大的挑战。本文介绍了在切开输尿管口囊肿后，在扩张的输尿管远端逆行使用 Lithoclast Select 的方法。
患者为 64 岁女性，右侧输尿管有大量结石，约有 15 个 1-2cm 大小的结石。她主要表现为右侧腰痛、尿急、尿频、尿痛和反复尿路感染。
插入 22Fr 硬性膀胱镜进入膀胱。尿道外口正常。患者有 2 个右侧输尿管口，符合完全双肾盂输尿管系统。在右侧输尿管口内侧发现一个非常大的输尿管口囊肿。下极系统无结石。检查上极系统时，发现远端输尿管内有大量结石。使用 Plasmacise Gyrus 通过将 Plasmacise 插入输尿管口并向前撑开，切开输尿管前壁。然后将 24Fr 肾镜插入远端输尿管。使用抓钳取出了许多结石碎片，但由于结石较大，有几块无法从远端输尿管中取出，因此在远端输尿管中使用超声碎石器将其破碎并吸出。还使用了 365µ 的激光光纤来破碎一些结石。没有出现并发症。术后 4 个月的 CT 扫描未见结石复发。最后一次随访是在术后 15 个月，患者情况良好。
在女性患者中，利用硬性肾镜和超声碎石器处理扩张的、有囊肿或切开的输尿管远端是安全有效的，可以治疗大于 15cm 的整个远端输尿管结石。
