男子尿管異所開口症例 付:本邦尿管異所開口228例の統計的観察

Abstract

1) Case report : A male 29, complained of hematuria an d pyuria. Pyelogram revealed a right ureteral stone with incomplete duplication of the ureter, and lateral displacement of the left kidney compressed by fist sized tumor mass. Left pyelogram was apparently normal (no reduction of any calyces). Seminal vesiculogram (thro u gh vasoseminal route) showed dilated ureter end terminating in the left seminal vesicle. Both ureteral orifices were essentially normal cystoscopically. This patient had 2 children and did not notice any ejaculatory distress. Supernumerary ectopic ureter opening into seminal vesicle with a nonfunctioning upper renal segment was diagnosed preoperatively. Operative exploration conf i rmed these findings i. e. hydroureteronephrosis of superior pole of duplicated kidney and ureter drained by corresponding kidney. Heminephrectomy and total resection of the ectopic ureter were performed. (Ureterolithotomy for the right ureteral stone had been performed 2 weeks before.) Post-operative course was uneventful. 2) A total of 228 cases of ectopic ureter (including male and female) found i n Japanese literatures were statistically analyzed chiefly concerning age, type (Thom), opening site, complication, and treatment. Concerning type , the most frequent is type III and then type II in Europe and U. S. A., but type I (70.6 %) and secondly type III (20.6 %) in Japan. Concerning opening site in female, the most frequen t is urethra or vestibule of vagina and thin vagina in Europe and U. S. A., but in Japan firstly vagina (66.6, °0) and secondly vestibule of vagina (14.4 %). In Japanese male, 5 cases open into seminal vesicle, 1 case into vas deference, and 1 case into ejaculatory duct. 3) Only 7 cases of male ectopic ureter w ere reported in Japanese literatures, and the above reported case was the 6 th one. In Japan the number of male patients was about 1/33 of that of female patients v. s. 1/2 to 1/3 in Europe and U. S. A.. This difference of male and female ratio between Japan and Western countries may b partly attributed to the considerable number of autopsy cases reported in the latter. Male cases are difficult to diagnose because clinical signs are not suggestive as in female (i. e. urinary incontinence), so that it is necessary to suspect ectopic ureter and perform detailed examination in male cases of unexplained pyuria, reccurent or persistent epididymitis, and when duplication is suspected urographically where a segment of renal parenchyma has no apparent calyceal drainage. 4) A total of 10 cases of ectopic u r eter experienced in our clinic were shown briefly in the table 11.