前列腺巨大结石伴不典型泌尿系结核一例并文献复习

Huge Prostatic Calculi with Atypical Urinary Tuberculosis: A Case Report and Literatures Review

目的伴钙化,左肾积水,膀胱结石(直径6cm),前列腺巨大或显示不清。截石位腔镜见前尿道全程狭窄且苍白僵硬,尿道扩张无效,置入输尿管硬镜。严重膨大的后尿道被巨大黄褐色粗糙质硬结石完全梗阻,镜体无法绕过结石,难以辨别膀胱和膀胱颈部全貌。被迫改下腹切口以便膀胱切开取石,意外发现膀胱极度萎缩,仅似鸭蛋大小,壁厚硬,巨大结石不在膀胱内,从膀胱颈口只能扪及结石边角。巨大结石的总体积超过挛缩膀胱约2倍,考虑难以切开膀胱颈部碎石取石及耻骨后取石,予下腹留置F24膀胱造瘘管,经尿道钬激光碎石长达8h。结果回顾诊疗,术前考虑膀胱结石,术中发现前列腺巨大结石,术后结合右肾萎缩、左肾积水、膀胱挛缩、全尿道狭窄及化验结果,最终诊断泌尿系结核,加做抗痨治疗。结论前列腺巨大结石伴泌尿系结核者,尚未见报道,给治疗额外增加困难,值得临床留意。

Objective The paper reports the rare diagnosis and treatment of a patient who suffered by a huge prostate stone with atypical urinary tuberculosis on the basis of previous articles. Methods A 55-year-old man complained of left lower abdominal pain for more than one year. He deliberately denied any lumbago, hematuria or dysuria, and denied any history of pulmonary tuberculosis. Ultrasound and CT showed that his right kidney had been distinctly atrophy with a little calcification, whereas his left renal pelvis had presented 24 cm hydronephrosis. What`s more,a huge quasi-circular stone(Φ 6 cm) located in his bladder and symphysis pubis area. His anterior urethral lumen was relatively narrow, pale and stiff, and the urethral dilatation was ineffective. F9 rigid ureteroscopy could be only used to insert into his urethra. The posterior urethra and bladder area were completely obstructed by huge yellow brown rough hard stones, and the ureteroscopy could not bypass the stone to get a full view of the bladder. The severely enlarged posterior urethra had been completely obstructed by a huge yellow brown rough hard stone so that the ureteroscopy could not bypass the stone margin, and it was difficult to distinguish the full view of bladder and bladder neck. Then, a lower abdominal incision was obliged to adopt for the purpose of supplementary removing the huge stone from the bladder. What’s unexpected is that,the bladder was extremely atrophic as the size as a duck’s egg with very thick and hard wall, and the huge stone was not in the bladder cavity.Only a few edges of the stone could be hardly touched nearby the bladder neck. Owing to the stone was about twice as large as the contractural bladder, it is very difficult to wholly extract and take out the stone either from bladder neck way or the posterior pubic gap. At last, percutanous cystostomy with a F24 thick tube was dwelled in the small bladder and transurethral holmium laser lithotripsy for consecutively 8 hours were carried out to time-consuming clean the huge stone. Results Reviewing the diagnosis and treatment, considering bladder stones before surgery,huge stones in the prostate were found during the operation, combined with right kidney atrophy, left hydronephrosis, bladder contracture, total urethral stricture and laboratory results, and finally diagnosed urinary tuberculosis, plus anti-tuberculosis treatment. Conclusion Huge stones of the prostate with tuberculosis of the urinary system have not yet been reported, which makes treatment more difficult and is worthy of clinical attention.