Coman Flavia, Codău Catrinel-Ana, Novac Bogdan
Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Urology and Kidney Transplant Clinic, "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania.
Arch Clin Cases. 2025 Mar 19;12(1):51-53. doi: 10.22551/2025.46.1201.10312. eCollection 2025.
Ureteral lithiasis in high-risk patients demands a personalized approach due to the interplay of multiple comorbidities and procedural risks. This case report examines a 66-year-old female with recurrent lower ureteral stones resistant to multiple extracorporeal shock wave lithotripsy sessions, complicated by multidrug-resistant infections, chronic coronary syndrome, heart failure with preserved ejection fraction, diabetes mellitus, and a history of ischemic stroke. The failure of conservative treatments required a shift to ureteroscopic laser lithotripsy, preceded by cardiovascular risk optimization and targeted antimicrobial therapy based on advanced microbial diagnostics. Postoperative imaging confirmed complete stone clearance and correct stent placement, ensuring ureteral patency. This case underscores the necessity of multidisciplinary management, integrating precise infection control, cardiovascular stabilization, and minimally invasive techniques to achieve a favorable outcome in a complex patient.
高危患者的输尿管结石由于多种合并症和手术风险的相互作用，需要个性化的治疗方法。本病例报告研究了一名66岁女性，她患有复发性输尿管下段结石，对多次体外冲击波碎石治疗均有抵抗，并发多重耐药感染、慢性冠状动脉综合征、射血分数保留的心力衰竭、糖尿病以及缺血性中风病史。保守治疗失败后，需要转向输尿管镜激光碎石术，在此之前要进行心血管风险优化，并根据先进的微生物诊断进行针对性抗菌治疗。术后影像学检查证实结石完全清除且支架放置正确，确保了输尿管通畅。本病例强调了多学科管理的必要性，整合精确的感染控制、心血管稳定和微创技术，以在复杂患者中取得良好结果。
