Spencer Evan, Baber Jacob, Ferretti Mark
Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania.
Geisinger Northeast Urology Department, Wilkes-Barre, Pennsylvania.
J Endourol Case Rep. 2019 Dec 2;5(4):178-180. doi: 10.1089/cren.2019.0058. eCollection 2019.
There have been >50,000 dextranomer-hyaluronic acid implants performed since 2001, and each has the potential to calcify. Although they are most often asymptomatic, these calcifications may mimic large distal ureteral calculi and are often misidentified on CT performed for suspected urolithiasis or other complaints. We report the case of a 21-year-old woman who presented with symptoms consistent with obstructive uropathy who was reported to have bilateral ureteral-vesicular junction calculi on abdominal CT evaluation. On further questioning she relayed the history of a vague urologic procedure as a child but was unable to characterize it further. On the basis of her relatively mild symptoms, urinalysis and renal ultrasonography were obtained demonstrating bilateral ureteral jets and she was diagnosed with nonobstructing bilateral dextranomer-hyaluronic acid calcifications and a presumed urinary tract infection that resolved with empiric antibiotic therapy. Accurate diagnosis of implant calcification is critical to effective therapy and avoiding unnecessary radiation or anesthesia. This diagnosis should be suspected with radiologically demonstrated large ureteral calculi but relatively mild presenting symptoms. As dextranomer-hyaluronic acid implantation is routinely performed in young patients it is also possible that this relevant history will not be reported.
自2001年以来，已进行了超过50000例葡聚糖凝胶-透明质酸植入手术，每一例都有钙化的可能。虽然这些钙化大多没有症状，但可能会被误诊为远端输尿管大结石，在因疑似尿路结石或其他症状而进行的CT检查中常被误认。我们报告一例21岁女性病例，她表现出与梗阻性尿路病相符的症状，腹部CT检查报告显示双侧输尿管膀胱连接部结石。进一步询问得知，她童年时有过一次模糊不清的泌尿外科手术史，但无法提供更多细节。基于她相对较轻的症状，进行了尿液分析和肾脏超声检查，显示双侧输尿管有喷射现象，她被诊断为双侧非梗阻性葡聚糖凝胶-透明质酸钙化，并推测有尿路感染，经经验性抗生素治疗后痊愈。准确诊断植入物钙化对于有效治疗和避免不必要的辐射或麻醉至关重要。当影像学显示有大的输尿管结石但症状相对较轻时，应怀疑有这种诊断。由于葡聚糖凝胶-透明质酸植入手术常在年轻患者中常规进行，也有可能不会报告这一相关病史。
