内視鏡的腎尿管結石手術における尿管損傷

概要

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Percutaneous and transurethral removal of renal and ureteral calculi was performed in 109 cases. Targeted calculi were successfully removed in 105 cases (96.3 per cent), but in five cases combined percutaneous and transurethral procedures were required. Although endourological stone removal resulted in low morbidity rates in many other series, some major complications have also been reported. They include arteriovenous fistula, colo-cutaneous fistula, nephro-duodenal fistula and ureteral avulsion. There were two severe complications in our early experience as well. In one case, a ureteral stenosis was found seven months after two sessions of percutaneous ultrasonic lithotripsy for an upper ureteral stone, and in the other case, a mid-ureteral avulsion was caused by ureteroscopic manipulation. Besides these, we experienced several minor pelvic and ureteral perforations which were easily controlled only by ureteral stent placement. Causes and management of ureteral complications in endourological treatment of renal and ureteral calculi are discussed.