尿路結石による腎盂破裂の2例

Abstract

症例1は62歳男で, 全身状態が比較的良好で結石も小さかったため, 自然排石と腎盂の自然修復が期待できると判断して経過観察した.その結果, 時間は要したものの自然排石・修復に至った.症例2は82歳で, 全身状態が悪く, 結石が嵌頓していた.このため腎盂破裂の治療にあたっては尿路カテーテルが入らない可能性も考えて経皮的腎瘻造設術を選択・施行し, その後体外衝撃波結石破砕術を3回行ったところ良好な結果が得られた

Two cases of renal pelvis rupture caused by urolithiasis are reported. The first case was in a 62-year-old male who had left flank pain. Urological examination including drip infusion pyelography (DIP) and abdominal computed tomography (CT) revealed a spontaneous rupture of the left renal pelvis. The rupture was assumed to have been caused by a small ureteral stone. The stone passed spontaneously, and the extravasation disappeared with conservative therapy. The second case was in a 84-year-old male who was admitted with high fever. Urological examination including DIP and abdominal CT showed a suspected rupture of the left renal pelvis due to a renal stone at the ureteropelvic junction. Percutaneous nephrostomy was performed and antegrade pyelography showed extravasation from the left renal pelvis. Extravasation disappeared on the 12th postoperative day. Extracorporeal shock wave lithotripsy was performed three times. The renal stone was completely discharged and the nephrostomy tube was removed successfully.