対側尿管結石を合併し腎機能障害をきたした尿管ポリープの1例

Abstract

46歳男.肉眼的血尿, 右下腹部痛, 背部痛, 欠尿を主訴とした.血液生化学検査にて腎機能低下, 貧血, 血小板減少を認め, 腹部エコー, KUBにて両側水腎症および左尿管内の結石を認めた.以上の所見より, 両側尿管閉塞による腎後性腎不全と診断した.両側single-J尿管ステントを留置したところ, 直後より利尿良好となり, 入院7日目に腎機能は改善傾向を示し, 左経尿道的尿管結石砕石術を行った.右尿管鏡検査にて腫瘍性病変を認め, 生検を行い, 病理学的に線維上皮性ポリープと診断した.術後3日目に左尿管ステントを抜去し, 右腎盂内にdouble-J尿管ステント留置し, 3ヵ月毎の交換を行うこととした.5ヵ月経過後, 腎機能は安定している

A 46-year-old man was admitted to our hospital complaining of macroscopic hematuria with dull pain in the right flank. Laboratory finding showed renal dysfunction and abdominal ultrasound sonograph revealed bilateral hydronephrosis (right > left). Retrograde pyelography showed left ureteral calculi and a filling defect in the middle portion of the right ureter. Renal function improved after bilateral single-J ureteral stent placement. Selective wash cytology of right renal pelvis was class II. Ureteroscopy demonstrated right ureteral obstruction with smooth-surfaced protruded tumor and cold cup biopsy was performed. Histopathological diagnosis was a fibroepithelial polyp but with no malignancy. In addition, left transurethral lithotripsy was performed under ureteroscopy. After the endoscopic examination, a double pigtail stent inserted into the right ureter. We performed conservative management by repeat urine cytologies and retrograde pyelography due to thrombocytopenia. The urine cytologies all proved negative and retrograde pyelography showed no abnormal changes. A ureteroscopic procedure is considered to be useful for the diagnosis of ureteral polyps. Transurethral resection of ureteral polyps with a ureteroscope is recommended for treatment.