输尿管结石的输尿管镜气压弹道碎石术治疗

目的探讨提高治疗输尿管结石疗效的方法。方法对146例(153侧)输尿管结石行输尿管镜气压弹道碎石术治疗。结果输尿管上段结石32侧气压弹道碎石成功率为53.1%;输尿管中段结石15侧气压弹道碎石成功率为66.7%;输尿管下段结石106侧气压弹道碎石成功率为95.3%。治疗输尿管结石总成功率为83.7%(128/153),手术并发症为2.6%(4/153)。结论经尿道输尿管镜气压弹道碎石术是治疗输尿管结石的一种安全、有效的方法。     

ESWL for stone in a retrocaval ureter: A case report

A male patient with retrocaval ureter and right renal calculus is reported. Stone treatment by ESWL was successful and the patient became stone free after 10 weeks.     

Foreign body stone of the ureter as a complication of acupuncture.

A case of spontaneous passage of a foreign body in the upper urinary tract is reported. Approximately 60 cases have been collected and reported in the world, 18 in Japan. Our case is, however, the first with spontaneous passage. As complications may occur if these foreign bodies are left behind, we advocate the surgical removal as treatment of choice.     

Ureterocele containing calcified stone

We describe here an uncommon case of simple ureterocele containing calcified stone, that was successfully treated.     

Ectopic ureter accompanied by giant ureteral stone and pyonephrosis

We report a rare case of ectopic ureter accompanied by a giant ureteral stone and pyonephrosis. A 19-year-old Japanese woman consulted our hospital due to low-grade fever and pain in the left flank. The patient had seeping urinary incontinence since childhood. Ultrasonography demonstrated left dysplastic lumbar kidney with hydronephrosis and plain kidney-ureter-bladder film showed a left giant ureteral stone. The left kidney showed no excretion of contrast medium on drip infusion pyelography. After further examination, a diagnosis of left simple ectopic ureter emptying into the vagina was made. Percutaneous nephrostomy penetrating the major psoas muscle was carried out for intractable pyonephrosis, followed by left nephroureterectomy and lithectomy. These procedures resulted in improvement in the patient's symptoms.     

Giant stone in a complete duplex ureter with ureterocele. A case report

We describe a case of a monolateral duplex system and a ureterocele containing a gigantic stone in a 65-year-old woman who presented with pyelonephritis without any previous history of urinary tract infections or stone disease. Stone removal and double left ureteroneocystostomy with plastic widening of a narrowed obstructive side were performed. The ureteral stone measured 10.5 cm in greatest diameter, weighed 85 g and contained calcium oxalates and phosphates. Three months after surgery, radiology (intravenous urography and cystography) showed left unobstructed upper and lower urinary tracts and the absence of vesicoureteral reflux. Urine culture was negative 3, 6 and 9 months after surgery.     

Inguino-scrotal herniation of the ureter containing stones

Background

Inguino-scrotal herniation of the ureter is a rare and difficult situation for a surgeon, especially if only recognized during inguinal hernia repair.

Methods

An 83-year-old gentleman, with a previous history of radiation treatment for squamous anal cancer, presented with a large left inguinoscrotal hernia causing occasional pain at the base of the scrotum. Follow-up, post-radiation therapy CT scan showed a hernia sac containing the bladder and large bowel. Calcifications in the sac were interpreted as bladder stones, in keeping with the history of left renal calculi.

Results

During hernia repair careful dissection revealed a herniated portion of the left ureter located alongside a large hernia sac, complicated by ureteral calculi. Following stones extraction and ureteral repair, hernia repair with mesh was successfully accomplished. Pathogenesis of ureteric herniation is reviewed.

Conclusion

A herniated ureter is potentially a source of serious renal or ureteral complications. When discovered, ureteric hernias should be surgically repaired. If preoperative detection of a ureter herniation alongside an inguinal hernia is missed, awareness of the existence of this condition may help avoid iatrogenic ureteral damage injury during a complex hernioplasty. Documentation of unexplained, sizeable and distinct calcifications in an inguino-scrotal hernia sac, particularly in a patient with a history of urolithiasis, may suggest the presence of a herniated, calculus-filled ureter. In such cases, retrograde pyelograms may be considered for a definitive diagnosis prior to surgery.

     

Right renal stone on the trajectory of upper left ureter

We report a 52-year-old woman with a right renal pelvic stone, mimicking a left upper ureteral stone in a kidney-ureter-bladder film. Computed tomography detected the exact anatomical location of the stone, which was not possible by intravenous urography and ultrasonography. In this study, we discuss diagnostic modalities of the urinary calculi in the light of the literature.     

Endoscopic treatment of a bile duct stone containing a surgical staple

We report a case of a pigmented gallstone which formed around a surgical staple in the bile duct. The stone was removed and retrieved endoscopically. A brief review of bile duct foreign bodies and gallstones is presented.     

A stone developed within the dilated intravesical ureter following ureteroscopy

A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.     

Foreign body stone of the ureter as a complication of acupuncture: report of a case]

A 47-year-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone acupuncture for left lumbago twelve years earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an acupuncture needle. Including our case, twelve cases of foreign bodies as a complication of acupuncture in the upper urinary tract reported in the Japanese literature were reviewed.     

Transurethral ureteroscopic extraction of stone from the ureter and renal pelvis

Use of a rigid ureteroscope for extraction of 19 ureteric and 6 renal pelvic stones is reported. One of the 24 patients had bilateral ureteric stone. The extraction was successful in 22 cases, including 9 after ultrasonic disintegration of stone. Surgical removal of stone was required because of failure of the ultrasound apparatus in one case and ureteric perforation in another. One stone was extracted "blind". The method has many advantages over more established procedures. It should be the preferred technique for management of ureteric calculi, and may be an option for some renal pelvic stones.     

Blind ending bifid ureter with stone in the blind branch: report of a case]

Blind ending bifid ureter is a rare anomaly in the urinary tract. This anomaly may result from failure of a premature branch of the ureteral bud to join with the metanephric blastema. A 21-year-old man was admitted with macroscopic hematuria and colic pain in the left flank region. Urinalysis demonstrated hematopyuria and excretory urography suggested bifid ending accessory ureter with a stone on the left side. Surgical exploration showed that the accessory ureter was bifurcated from the left ureter at about 5 mm from the bladder wall and ran parallel with the left ureter. Although dense adhesions to the surrounding tissue existed, the accessory ureter was resected at the site of the junction. It measured 3 cm in length and 1 cm in greatest diameter. The stone found at the tip of the accessory ureter was composed of calcium oxalate (24%) and calcium phosphate (76%). Histological examination revealed that the ureter had all layers of normal ureteral structure and no renal tissue was identified in the specimen resected. During a follow-up period of 22 months after the operation, he was free of urinary tract infection and abdominal pain. Of 77 cases with blind ending bifid ureter reported in the Japanese literature, a ureteral stone was found in the blind branch in only 5 cases.     

Small bowel perforation after extracorporeal shockwave lithotripsy of an ureter stone.

A 60-year-old man was treated by extracorporeal shock wave lithotripsy (ESWL) for an impacted ureter stone. Two days after the procedure he developed an acute abdomen. On laparotomy, a small bowel perforation in the area of an adhesion to the abdominal wall was found. The adherent intestinal segment was located exactly in the range of the ESWL field, so that excluding further reasons the shockwave lithotripsy must be assumed to be causative.     

后腹腔镜在输尿管切开取石术中的应用

目的探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。方法2006年12月至2009年9月,对66例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,以4-0人工合成可吸收线（SAS）间段缝合输尿管切口。结果66例手术均获成功,无中转开放手术,结石清除率100％。术后创腔引流液量少,无一例发生尿漏。3-5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1-33个月,平均16.3个月,超声复查显示肾积水明显好转或消失,无结石复发。结论后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小,疗效好、术后恢复快等特点,明显优于开放手术及其他手术,值得推广应用。     

输尿管镜治疗输尿管结石(附412例报告)

目的探讨412例输尿管镜治疗输尿管结石的疗效。方法我科自2001年1月至2005年1月,对412例输尿管结石经输尿管镜碎石及取石治疗进行回顾性分析。结果412例患者经输尿管镜成功取出结石372例,成功率为90.3%,其中上段32例,中段91例,下段274例。结论输尿管镜取石术,是治疗输尿管结石尤其是中下段输尿管结石的重要手段。在输尿管导管引导下入镜,术后留置输尿管导管,可提高取石成功率,降低并发症。     

A new alternative treatment for entrapped stone basket in the distal ureter

We describe an alternative method for the treatment of an entrapped stone basket. When efforts to remove an engaged stone through the intramural ureter met with marked resistance, the basket with the stone within it was advanced into the renal pelvis. Extracorporeal shock wave lithotripsy then was used to pulverize the stone, allowing successful removal of the basket.     

后腹腔镜与微创经皮肾镜手术治疗复杂输尿管上段结石的疗效比较

目的 比较后腹腔镜输尿管切开取石术(RLU)与微创经皮肾镜取石术(MPCNL)治疗复杂输尿管上段结石的临床疗效.方法 单侧复杂输尿管上段结石患者129例,其中79例行RLU治疗,50例行MPCNL治疗,比较两组病例的手术成功率,手术时间,术后1周结石清除率及手术相关并发症的发生率.结果 RLU组平均手术时间(37.43±22.63) min,术后发热5例,结石清除率100％(79/79),MPCNL组平均手术时间(48.52±17.51)min,术后发热3例,结石清除率94％(47/50).RLU组平均手术时间较短,结石清除率高于MPCNL(P＜0.05)；两组在手术成功率,并发症发生率方面差异无统计学意义(P＞0.05).结论 两种方法均适用于复杂输尿管上段结石的处理,相比较而言,RLU处理单纯的复杂输尿管上段结石更为合理.