3年間放置された両側尿管ステントに発生した多発結石に対し内視鏡的に治療を行った1例

Abstract

52歳男.3年前, 腎尿管結石に対して体外衝撃波砕石術(ESWL)目的で両側尿管ステントを留置されたが, そのまま放置していた.今回, 血尿, ふらつきを認め受診となった.入院時検査にて炎症反応, 腎機能障害, 貧血をいずれも軽度であるが認め, 尿所見ではリン酸アンモニウムマグネシウム結晶(+), 尿培養にてE.coliを認めた.KUBでは, 残存した尿管ステントに左腎サンゴ状結石, 左巨大尿管結石, 膀胱結石を認め, CTにて両側の水腎症を認めた.両側水腎症に対して両側腎瘻造設術を施行後, ureteroscopic lithotripsy, percutaneous nephroscopic lithotripsy(PNL)を併用して, 結石が附着した尿管ステントを除去した.左腎結石に対してPNL, ESWLを行った.退院後4ヵ月, 結石の再発を認めていない

A 52-year-old man had bilateral ureteral stents placed before treatment for ureteral and renal stones, but did not return for treatment and follow-up. Three years later, he complained of hematuria and vertigo. An abdominal X-ray revealed large renal and ureteral stones rising from and enveloping the stent. A bilateral percutaneous nephrostomy was placed. The right ureteral stent was easily removed with a cystoscope. The left ureteral stone was separated from the stent by ureteroscopic lithotripsy (TUL) and percutaneous nephroscopic lithotripsy (PNL). The left stent was torn off and difficult to remove because of encrustation. It was finally removed through an endoscopic procedure. Right PNL and extracorporeal shock wave lithotripsy (ESWL) were performed and all stones and stents were extracted. He was stone-free at 4 months.