永军外语20170909一斤半多重的

克的膀胱结石

A64-year-oldmanpresentedtotheemergencydepartmentwitha3-dayhistoryofpainintheleftflankandurinaryretention.Hehadundergoneradicalcystectomyandorthotopicneobladderconstructionwithintestinalsegmentsmorethanadecadeearlierbecauseofinvasivebladdercancer.Physicalexaminationrevealedtendernessintheleftflank.Computedtomographyoftheabdomenandpelvisshowedanobstructingstoneintheleftproximalureter(arrow)andaverylargestoneintheneobladder(PanelsAandB).Theuseofintestinalsegmentstocreateurinarydiversionscanleadtostonediseaseasaresultofpersistentbicarbonatelossintheurine,hyperoxaluria,andlong-termcolonizationofurea-splittingbacteriaintheurinarytract.Additionalrisksforstoneformationinacontinenturinaryreservoir,suchasinourpatient’sneobladder,includeurinarystasis,mucusproduction,andnonabsorbablesurgicalmaterialsusedtoconstructthesubstitutebladder.Thestoneintheleftureterwasaccessedbymeansofpercutaneousnephrostomywithantegradeureteroscopicassistanceandwasremovedwiththeuseoflaserlithotripsy.Thepatientunderwentanopenneocystolithotomytoextracttheneobladderstone,whichwaseggshapedandmeasured12cmby9.5cmby7.5cm,weighedg,andwas







































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