Zhu Kejia, Chang Yao, Zhao Delong, Guan Yong, Ding Sentai
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China.
Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China.
Exp Ther Med. 2023 Apr 18;25(6):257. doi: 10.3892/etm.2023.11956. eCollection 2023 Jun.
Treatment of kidney and ureter multiple calculi is a difficult procedure in urology. It is especially difficult to eliminate the high burden stones in a one-stage operation. When a patient has had only one kidney since he/she was born (a condition termed 'solitary kidney'), the conservation of the renal function is especially important. A series of combined surgery techniques have been developed, including endoscopic combined intrarenal surgery, extracorporeal shock wave lithotripsy sandwich therapy and laparoscopy-assisted percutaneous nephrolithotomy, but not laparoscopy or endoscopy cooperative surgery. The present study described the case of a patient with a solitary kidney and ureter who developed multiple calculi. This condition led to hydronephrosis and severe anuria for 3 days. Urinary ultrasound indicated hydronephrosis of the left kidney and several stones were detected. The maximum renal stone was sized ~2.7x0.8 cm. In addition, a maximally sized stone of 2.9x0.9 cm was found in the left upper ureter. The patient had only one kidney, the right kidney was absent. Laboratory examinations revealed severe renal dysfunction. A percutaneous nephrostomy was immediately performed on the left kidney. Laparoscopy, flexible ureteroscopy, rigid ureteroscopy and ureteroscope pneumatic lithotripsy were used to eliminate all the stones in one stage. The patient recovered well and was discharged on the eighth day post-surgery. The present case report highlighted that the conservation of kidney function is critical in the treatment of anuria lasting for 3 days in a patient with calculus. When the situation arises, laparoscopy combined with ureteroscopy cooperative surgery was shown to be a good choice for one-stage clearance of complex stones in patients with a solitary kidney and ureter.
肾脏和输尿管多发结石的治疗是泌尿外科中的一项难题。在一期手术中清除高负荷结石尤其困难。当患者自出生起就只有一个肾脏（这种情况称为“孤立肾”）时，肾功能的保留尤为重要。一系列联合手术技术已被开发出来，包括内镜联合肾内手术、体外冲击波碎石三明治疗法以及腹腔镜辅助经皮肾镜取石术，但不包括腹腔镜或内镜协同手术。本研究描述了一名患有孤立肾和输尿管且并发多发结石患者的病例。这种情况导致肾积水和严重无尿3天。泌尿系统超声显示左肾积水，并检测到数颗结石。最大的肾结石大小约为2.7×0.8厘米。此外，在左输尿管上段发现一颗最大尺寸为2.9×0.9厘米的结石。该患者只有一个肾脏，右肾缺如。实验室检查显示严重肾功能不全。立即对左肾进行了经皮肾造瘘术。采用腹腔镜、软性输尿管镜、硬性输尿管镜及输尿管镜气压弹道碎石术一期清除所有结石。患者恢复良好，术后第8天出院。本病例报告强调，在治疗结石患者持续3天的无尿情况时，保留肾功能至关重要。在这种情况下，腹腔镜联合输尿管镜协同手术被证明是孤立肾和输尿管患者一期清除复杂结石的良好选择。
