Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, China (mainland).
International School, Jinan University, Guangzhou, Guangdong, China (mainland).
Am J Case Rep. 2023 Jun 4;24:e939700. doi: 10.12659/AJCR.939700.
BACKGROUND Percutaneous nephrolithotomy (PCNL) is indicated for large renal calculi (≥2 cm) and is often the treatment of choice due to its high success rate. Guidewire fragmentation is a rare procedural accident that can occur in PCNL but may be missed. Retention of the fragment within the upper urinary tract can lead to further complications, such as recurrent nephrolithiasis or impairment of renal function. CASE REPORT We present the case of a 54-year-old man who experienced right flank pain for 5 days. His history was significant for recurrent nephrolithiasis, managed by PCNL in other hospitals. The most recent procedure was conducted 4 years ago, and his perioperative course was uneventful. Preoperative computed tomography revealed right renal calculi and a C-shaped foreign body. He was scheduled for an elective PCNL. The foreign body was intraoperatively identified as a guidewire fragment and removed. CONCLUSIONS Currently, there is no standard management for intrarenal foreign bodies. Suspicion should be raised in young patients with recurrent stones within a short period of time. A thorough history on past urological interventions should be obtained. Symptoms can also have an insidious onset that could mimic nephrolithiasis or urinary tract infections. Extraction can be done via a standard minimally invasive approach. It is also the surgeon's responsibility to check the integrity of intraoperative instruments so as to minimize risks of complication and reassure the patient.
经皮肾镜碎石术（PCNL）适用于大肾结石（≥2cm），由于其成功率高，通常是首选治疗方法。导丝碎裂是 PCNL 中罕见的手术事故，但可能会被忽视。碎片在上尿路内的滞留可导致进一步的并发症，如复发性肾结石或肾功能损害。
我们报告了一名 54 岁男性的病例，他因右侧腰痛 5 天就诊。他的病史有复发性肾结石，曾在其他医院接受 PCNL 治疗。最近一次手术是在 4 年前进行的，围手术期无并发症。术前 CT 显示右肾结石和 C 形异物。他被安排择期行 PCNL。术中发现异物为导丝碎片并将其取出。
目前，对于肾内异物尚无标准的处理方法。对于在短时间内反复出现结石的年轻患者，应怀疑存在异物。应获取有关过去泌尿外科干预的详细病史。症状也可能隐匿起病，可模拟肾结石或尿路感染。可以通过标准的微创方法进行取出。外科医生还应负责检查术中器械的完整性，以最大程度地减少并发症风险并使患者安心。
