腎盂尿管移行部狭窄症の経皮的内視鏡手術後に経験した尿管合併症の1例

Abstract

A case of ureteral complication observed after endopyelotomy is reported. A 19-year-old female patient suffering from right hydronephrosis due to uretero pelvic junction stenosis was treated with endopyelotomy. The stenotic ureter was incised by cold knife for a distance of 5 cm through full thickness. The cut ureteral segment was intubated with a ureteral stent catheter of 10 Fr calibre. The top of the catheter was advanced 1 cm from the edge of the incised ureter. To prevent protrusion of the catheter tip, a flexible guide wire 0.038 inches in diameter was inserted into the catheter and the tip of the guide wire was advanced to the bladder. Antegrade pyelography performed 3 weeks after the operation revealed a lesion resembling a pseudo-ureter. It was made by the catheter that had slipped out of the incised ureter. The lumen of the true ureter was also preserved without stenosis. After removal of the stent catheter and safety guide wire, the true ureter was intubated with a double J catheter of 10 Fr calibre. One week later the pseudo-ureter was not demonstrated by excretory urography performed. Finally, hydronephrosis due to uretero pelvic junction stenosis was treated successfully.