硬性尿管鏡による腎孟結石の治療経験

Abstract

1) 5例の腎盂結石と5例の腎盂尿管移行部結石に対し, 経尿道的に硬性尿管鏡で治療を試みた.砕石手段は, 超音波破砕器と生検鉗子を用いた.2) 10例中2例は尿管鏡による砕石が行えなかった.5例は, 初回の尿管鏡の砕石術後, 2ヵ月以内に砕石片の自然排石によって治療が達成された.術後2ヵ月以上大残石がみられた3例のうち2例は, 追加治療(結石溶解療法, 再度の尿管鏡)によって, 残石は消失した.3)腎内腎盂の腎盂結石は尿管鏡による経尿道的砕石術は困難と思われた.4)合併症は, 腎洞と尿管からの尿溢流がそれぞれ1例に起こったが, 保存的な治療によって予後は良好であった

Ten patients with renal pelvic stones were treated by rigid ureterorenoscopy. Ultrasound lithotriptor and biopsy forceps were used for disintegrating the stones. The stones of 5 patients were disintegrated into small fragments that passed spontaneously within 2 months after the procedure. The stones of 2 failed to disintegrate for migration of the stones into the calices. Retention of the large fragments in the calices occurred in 3 patients. Residual fragments of urate were dissolved completely by urine alkalinization 5 months later in 1 patient. In another patient the fragment had fallen into the ureter and it was extracted by ureterorenoscopy 8 months later. After all, the success rate was 70% in this series. The disintegration of stones in the small intrarenal pelvis has proved to be difficult when they are approached by retrograde ureterorenoscopy. There were 2 complications of ureterorenoscopy: extravasation of urine from the renal sinus, and from the upper ureter. These minor injuries were treated by stenting without sequelae.