尿管皮膚瘻造設術後に生じた尿管結石に対して尿管アクセスシースを用いて逆行性尿路結石破砕術を施行した1例

Abstract

A 65-year-old man presented with a history of rectal cancer 20 years prior that led to the development of a cutaneous ureterostomy and a colostomy. Subsequently, the patient was diagnosed with acute complicated pyelonephritis due to a right ureteral stone. After the placement of a single J ureteral stent in the right ureter for therapeutic management, the patient was referred to our institution for treatment of the right ureteral stone. An abdominal computed tomography (CT) revealed an 11×8 mm stone in the upper right ureter. A 10/12 Fr ureteral access sheath was inserted through the cutaneous ureterostomy and retrograde ureteroscopic lithotripsy was performed. Although a febrile urinary tract infection appeared postoperatively, the patient was discharged on the sixth postoperative day. At postoperative 1-month, CT showed no residual stones and no hydronephrosis. The use of a ureteral access sheath in performing retrograde ureteroscopic lithotripsy effectively managed the ureteral stone with cutaneous ureterostomy.