BILATERAL CALCIFIED URETERAL STRICURE REQUIRING URINARY RECONSTRUCTION IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS: A CASE REPORT

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  • 両側尿管の石灰化狭窄を呈し尿路再建術を要した好酸球性多発血管炎性肉芽腫症の1例

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Abstract

<p>Calcified ureteral obstruction is a rare complication of vasculitis. Only a few cases of eosinophilic granulomatosis with polyangiitis (EGPA) have been published. We herein report a case of successful surgical repair of bilateral ureteral strictures in a patient with EGPA. A retrograde pyelogram revealed complete bilateral ureteral obstruction in the patient. Bilateral nephrostomies were placed because we were unable to introduce a double-J stent. The vasculitis and eosinophilia both responded to immunosuppressive therapy, but ureteral obstruction persisted. Surgical reconstruction was elected in order to eliminate the need for permanent external drainage. A combined nephrostogram/retrograde ureterogram revealed a 10 cm right ureteral gap and a 3 cm left ureteral gap. The left ureter was amenable to end-to- end anastomosis, pyeloureteroplasty, but repair of the right ureter required interposition of intestinal tissue. Right ureteral reconstruction was performed by combining the Yang-Monti ileal ureteral substitution and appendiceal interposition with a psoas hitch. The isolated appendix was interposed in an antiperistaltic fashion between the Yang-Monti tube and bladder. His kidney function has remained normal, and he is without vasculitic symptoms.</p>

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