TULに伴う医原性右尿管損傷に対する虫垂利用尿管置換術

A Case of Appendiceal Ureteral Interposition for Latrogenic Right Ureteral Injury Associated with TUL

　52歳男性，前医で右腎結石に対し経尿道的尿路結石破砕術（TUL）を施行した際に近位尿管を損傷し，裂傷部を4-0吸収糸で修復した．後腹膜腔にドレーンを留置し閉創したが，術後より右腎の尿がほぼすべてドレーンから流出するようになり当科に紹介された．損傷長は4cmにわたり，虫垂を用いた尿管置換術により良好な経過を得られた．尿管置換に利用されるグラフトとして何が最適か，いまだコンセンサスは得られておらず，若干の文献的考察を加えて報告する．

Abstract

A 52-year-old male underwent transurethral lithotripsy (TUL) for a right renal pelvic stone in a previous medical intervention. During the TUL procedure, the proximal ureter was damaged, and the laceration was repaired using 4-0 absorbable sutures through a right flank incision. However, after the surgery, almost all the urine from the right kidney began to flow out through the drain, leading to the patient's referral to our department. The extent of the injury was 4cm, and a successful outcome was achieved through ureteral interposition using the appendix. The optimal graft for ureteral interposition has not yet reached a consensus, and this report includes a brief literature review to provide some insights into this matter (Rinsho Hinyokika 78 : 703-708, 2024).