关键词: 尿路结石, 肾造口术, 经皮, 输尿管镜

Abstract: Upper urinary tract calculi with infection is a quite difficult acute urologic emergency. And what is more, upper urinary tract obstruction after radical cystectomy following urinary diversion may be fatal in the vulnerable patients with this kind of situation. Postoperative anatomy and other factors affect the upper urinary tract calculi, and urinary tract infection greatly increased the risk. But it is particularly difficult to handle with patients with poor general condition and septic shock treatment, so how to optimize the selection program is worth further studying. A 65-year-old man was admitted to hospital for combining with renal and ureteral calculi after radical cystectomy (Bricker) in March 2017. The patient underwent transurethral resection of bladder tumor in the outer court because of the discovery of bladder tumor one year before, The postoperative pathology was high-grade papillary urothelial carcinoma and he underwent regular irrigation of the bladder. Because of tumor recurrence, he came to Peking University Third Hospital for further treatment in August 2016, and the examination of urinary tract CT indicated bladder can-cer; for bilateral multiple renal pelvis and renal calices calculi, he was given laparoscopic radical cystecto-my. After four months, due to sudden chill fever, he was hospitalized. After definite diagnosis, anti-inflammatory treatment combined with left nephrostomy was given. The two-stage lithotripsy was performed. After expansion of the original left renal fistula to 24 F（1 F=0.33 mm）, 24 F sheath was inducted into the kidney. We introduced a flexible ureteroscopy into the channel down to the ureteral obstruction, where we found a 1 cm oval black brown stone obstructed. A guide wire was inducted through the stones down to ileal conduit in the right lower quadrant. Through the ureteroscopy, we made ureteral calculi broken into powder, and replaced the residual stones into the renal pelvis. Then we used the nephroscopy for lithotropsy in the pelvis, and finally we introduced a flexible cystoscopy for the residual stone. The operation was successful, the operation time was 181 min, and intraoperative bleeding was 10 mL. After operation, no residual stones were found in kidney, ureter, bladder (KUB) plain films. No operation complications were related to the urinary tract. Therefore, multiple endoscopy with combination therapy of upper urinary tract calculi following urinary diversion is safe and effective, and the reasonable choice with the advantages of each instrument can improve the stone clearance rate and shorten the operation time. This can be used as a useful complement to traditional treatment.

Key words: Urinary calculi, Nephrostomy, percutaneous, Ureteroscopes