Dong Ru-Nan, Kwan Kristine Joy Shan Joy Shan, Tang Jun-Feng, Yuan Jia-Bing, Xiong Lin
Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, China.
Department of Vascular Surgery, Fudan University Pudong Medical Center, Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China.
Am J Case Rep. 2025 Jun 27;26:e947262. doi: 10.12659/AJCR.947262.
BACKGROUND Large ureteral stones (LUSs) pose significant health risks, including chronic obstruction and renal impairment. Timely intervention is critical to preserve kidney function. While the optimal treatment for LUS is debated, retroperitoneal laparoscopic ureterolithotomy (RLU) is often preferred over percutaneous nephrolithotomy (PCNL), ureteroscopy, or extracorporeal shockwave lithotripsy due to its effectiveness. Combining RLU with antegrade flexible ureteroscopy (aFURS) can enhance stone clearance rates, addressing the challenges of intrarenal access and guidewire passage. CASE REPORT We report the case of a 65-year-old woman with a large proximal left ureteral stone (15×15×42 mm), renal atrophy, and severe hydronephrosis, presenting with persistent lumbar pain and intermittent hematuria. An urgent percutaneous nephrostomy (PCN) improved her renal function, yet left renal GFR was low at 10.62 ml/min. Forty-seven days post-PCN, she underwent a combined procedure of RPLU and aFURS through the PCN tract. This approach ensured complete stone removal while minimizing ureteral trauma. The stone was successfully fragmented and removed, followed by antegrade double-J stenting. The patient experienced an uneventful recovery and was symptom-free at the 3-month follow-up. Imaging confirmed the absence of residual stones and strictures. CONCLUSIONS This case underscores the effectiveness and safety of combining RPLU and aFURS for large ureteral stone removal in a single session. It highlights the importance of a multidisciplinary approach and surgical expertise in managing complex stone cases, offering insights into optimizing patient outcomes and minimizing complications.
背景 大型输尿管结石（LUS）会带来重大健康风险，包括慢性梗阻和肾功能损害。及时干预对于保护肾功能至关重要。虽然对于LUS的最佳治疗方法存在争议，但由于其有效性，腹膜后腹腔镜输尿管切开取石术（RLU）通常比经皮肾镜取石术（PCNL）、输尿管镜检查或体外冲击波碎石术更受青睐。将RLU与顺行性软性输尿管镜检查（aFURS）相结合可以提高结石清除率，解决肾内通路和导丝通过的挑战。病例报告 我们报告了一名65岁女性的病例，她患有左侧近端大型输尿管结石（15×15×42 mm）、肾萎缩和严重肾积水，表现为持续性腰痛和间歇性血尿。紧急经皮肾造瘘术（PCN）改善了她的肾功能，但左肾肾小球滤过率（GFR）较低，为10.62 ml/min。PCN术后47天，她通过PCN通道接受了RLU和aFURS联合手术。这种方法确保了结石的完全清除，同时将输尿管创伤降至最低。结石成功破碎并取出，随后进行顺行性双J管置入。患者恢复顺利，3个月随访时无症状。影像学检查证实无残留结石和狭窄。结论 本病例强调了在单次手术中联合RLU和aFURS治疗大型输尿管结石的有效性和安全性。它突出了多学科方法和手术专业知识在处理复杂结石病例中的重要性，为优化患者预后和减少并发症提供了见解。
