腎杯憩室: 3症例と本邦報告60例の検討

Abstract

Three cases of calyceal diverticulum were reported. Case 1 : A 50 year-old male was admitted to th e hospital with complaint of gross hematuria of two weeks' duration. Cystoscopic examination revealed a bloody stream spurted from the left ureteral orifice and retrograde pyelogram demonstrated a small diverticulum communicated with the upper calyx of left kidney. After segmental resection of the upper pole of left kidney the hematuria disappeared completely. Case 2 : A 36 year-old male visited our cl i n ic for abnormal calcification at the right upper quadrant in an abdominal plain film. Intravenous pyelogram showed a calyceal diverticulum filled with many small calculi of the right kidney. Segmental resetion of the upper pole of right kidney was performed. Case 3 : A 25 year-old male wa s admitted to the hospital with complaint of gross hematuria of four months' duration. Retrograde pyelogram demonstrated a diverticulum of 2 cm. in diameter communicated with the middle calyx of left kidney. After left nephrectomy the hematuria disappeared completely. The authors have co l l ected 57 clinical cases of calyceal diverticulum in Japanese literatures and added 3 personal cases making a grand total of 60 cases. The condition occurs in male about twice as frequent as in female and involves the right kidney slightly more often than the left. The condition is most commonly seen as single and unilateral type, and multiple and bilateral case have been reported in only one instance respectively. The youngest patients were 16 years old and the oldest 66 years. There were only 3 cases in the second decade and 2 in the seventh. The majority of the cases occurred in third (10 cases), fourth (18 cases), fifth (16 cases) and sixth decades (10 cases). Among 45 single cases, the diverticulum was situated at the distal to the terminal portion of the upper calyx in 36 cases, middle calyx in 5 cases and lower calyx in 4 cases. Calculi were present in 68 % of the cases and were more often multiple than single. The most frequent symptom noted in 45 cases was dull pain in the lumbar region on the affected side, and hematuria was observed in 13 cases. The diagnosis is made by excretory urography or retrograde pyelography which reveals a small regular cavity of a minor calyx. Among the 60 cases, operative treatment was carried out in 50 cases and consisted of excision in 5 cases, partial nephrectomy in 24 cases, nephrectomy in 21 cases and no operation was performed or recorded in 10 cases.