Related Experiment Videos
[Bilateral ureteral obstruction secondary to aneurysm of abdominal aorta: a case report]
1Department of Urology, Teikyo University School of Medicine, Ichihara Hospital.
Insights
This case study highlights managing bilateral hydronephrosis caused by an abdominal aortic aneurysm. Interventions included percutaneous nephrostomy and ureteral stenting, stabilizing renal function and aneurysm size.
Area of Science:
- Urology
- Vascular Surgery
- Nephrology
Background:
- Abdominal aortic aneurysms (AAAs) can compress adjacent structures, leading to complications such as hydronephrosis.
- Bilateral hydronephrosis secondary to AAA extension into the iliac arteries presents a complex clinical challenge.
- Management requires a multidisciplinary approach involving urological and vascular interventions.
Observation:
- A 66-year-old male presented with oliguria due to bilateral hydronephrosis secondary to an AAA involving bilateral internal iliac arteries.
- Initial attempts at retrograde ureteral stenting were unsuccessful, necessitating percutaneous nephrostomy for renal decompression.
- Surgical intervention for the AAA was performed, but complete resection was not feasible due to anatomical constraints.
Findings:
- Following nephrostomy and subsequent antegrade double-J ureteral stenting, urine drainage into the ureter was restored.
- The patient's renal function remained stable over a 25-month follow-up period.
- The abdominal aortic aneurysm size remained unchanged post-intervention.
Implications:
- Percutaneous nephrostomy and antegrade ureteral stenting can be effective in managing hydronephrosis caused by unresectable AAAs.
- Long-term management with regular stent exchange is crucial for maintaining renal function in such complex cases.
- This case underscores the importance of tailored, stepwise interventions for rare AAA-related urological complications.
Abstract:
A 66-year-old man with the chief complaint of oliguria had been referred to our hospital under the diagnosis of bilateral hydronephrosis and abdominal aortic aneurysm by his family doctor. CT scan and digital subtraction angiography demonstrated an abdominal aortic aneurysm continuing to bilateral internal iliac arteries. The degree of right hydronephrosis was less advanced compared to the left side. Right percutaneous nephrostomy was performed because the retrograde stenting was unsuccessful. After the renal function improved, an operation for the aneurysm was undertaken in the surgical department. Although bilateral ureterolysis was possible, the resection of the aneurysm could not be done. After clamping the nephrostomy catheter, drainage of urine into the ureter was not seen one month after the operation. A double-J ureteral stent was inserted by the antegrade approach and the nephrostomy tube was removed. By exchanging the stent every 3 months, the renal function has been stable and the size of the aneurysm unchanged during the 25 months after the surgery.