腎移植後の尿管膀胱吻合部結石の3例

Abstract

症例1(25歳男性).慢性腎不全で血液透析導入の1ヵ月後に生体腎移植を施行, 術後3ヵ月目に肉眼的血尿が出現し, 超音波検査で膀胱結石と診断, 経尿道的に摘出した.成分は尿酸98%であった.症例2(43歳男性).慢性腎炎で血液透析導入の7ヵ月後に生体腎移植を施行したが, 術後9年目に腎機能廃絶, 再度の腎移植腎も喪失した.全血漿交換を2回施行後3度目の生体腎移植を施行, 術後7ヵ月目に肉眼的血尿が出現し, CTで膀胱前壁に石灰化像を認め, 膀胱結石の診断で経尿道的に摘出した.成分はCaOx56%, CaP44%であった.症例3(53歳男性).慢性腎炎で血液透析導入し, 約4年後, 左腎renal cell carcinoma(RCC)に対し左腎摘除術後, 血液型不一致生体腎移植を施行した.自覚症状はなかったが術後15ヵ月目の超音波検査で結石を認め, 経尿道的に摘出した.RCCの再発は認めていない

Three cases of bladder stones at the ureterovesical anastomotic site after renal transplantation (RT) are reported. The three patients were successfully treated with kidney grafts. The method used for the ureter bladder anastomosis in all patients was the extravesical technique with polyglyconate (MaxonTM) for case 1 and a polydioxanone suture (PDSIITM) for cases 2 and 3. Calculi formation was found between 3 to 15 months after RT. Endoscopic vesicolithotripsy was performed and the stones adherent to the ureterovesical anastomotic site were removed successfully in all cases. Stone analysis revealed uric acid (case 1), CaOx and CaP (case 2). Stone analysis was not done in case 3. The patients' symptoms improved and no bladder stones could be discerned postoperatively.