Irizato Mariko, Sato Yozo, Murata Shinichi, Chatani Shohei, Ouchi Akira, Kinoshita Takashi, Yamaura Hidekazu, Inaba Yoshitaka
Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan.
Department of Radiology, Shiga University of Medical Science, Otsu, Japan.
Radiol Case Rep. 2024 Aug 14;19(11):4908-4911. doi: 10.1016/j.radcr.2024.07.079. eCollection 2024 Nov.
Ureteral obstruction after urinary diversion is not a rare complication, and the treatment is generally the ureteral stent placement via antegrade approach via the nephrostomy. We present a case of 64-year-old man with history of total pelvic resection and urinary diversion for local recurrence of rectal cancer who presented bilateral ureteral obstruction due to postoperative adhesion. First, bilateral nephrostomies were performed. The antegrade approach via nephrostomy could not break through the obstruction in the left side. Therefore, antegrade and retrograde approaches were attempted, and the internal-external drainage catheter could be placed by the rendezvous technique using bilateral microcatheters and microguidewires. The patient was able to avoid a permanent nephrostomy and continues to undergo regular internal drainage catheter exchange. Permanent nephrostomy considerably reduces the patient's quality of life, and in cases of tight obstruction, rendezvous techniques can be used.
尿流改道后输尿管梗阻并非罕见的并发症，其治疗通常是通过肾造瘘经顺行途径放置输尿管支架。我们报告一例64岁男性患者，因直肠癌局部复发接受全盆腔切除术及尿流改道，术后因粘连出现双侧输尿管梗阻。首先，进行了双侧肾造瘘。经肾造瘘的顺行途径未能突破左侧的梗阻。因此，尝试了顺行和逆行途径，并使用双侧微导管和微导丝通过会师技术放置了内外引流导管。患者避免了永久性肾造瘘，并继续定期更换内引流导管。永久性肾造瘘会显著降低患者的生活质量，在梗阻严重的情况下，可以使用会师技术。
