Encrusted cystitisの2例

Abstract

症例1は88歳女で, 肉眼的血尿, 下腹部の違和感, 頻尿, 腰痛を主訴とした.骨シンチで腰椎に強い集積を認めたことなどから初め膀胱悪性腫瘍とその骨転移を疑い経尿道的膀胱腫瘍切除術を施行したが, 病理組織学的に悪性所見は認められず, その後, 尿培養検査でCorynebacterium group D2(CGD2)を認めencrusted cystitis(EC)と診断した.腰痛は圧迫骨折によるものであった.治療は, CGD2に感受性のあったlevofloxacinの内服, Solution Gによる24時間膀胱内持続灌流, クランベリージュースの摂取などを行い改善した.症例2は85歳女で, 肉眼的血尿, 排尿時痛, 頻尿を主訴とし, 尿pHの異常高値, 尿培養検査でのCGD2検出, 病理組織学的所見などからECと診断した.Solution Gによる持続灌流を1週間行い, 症状, 検査所見とも改善した

Encrusted cystitis is a type of severe cystitis, which progresses chronically and is characterized by excessively alkaline urine and calcifications within the bladder wall. We report two cases of encrusted cystitis. Both cases were high aged and had severe anemia with chronic cystitis. They complained of gross hematuria, voiding frequency and pain upon urination. Urine pH was 8-9, and urine cytology was negative. Urine culture contained Corynebacterium Group D2. Abdominal computed tomography and transurethral resection revealed wall bladder wall calcification and inflammatory change. We diagnosed it as encrusted cystitis. The patients underwent excision of plaques of calcified encrustation, adapted antibiotic therapy and acidification of urine. It is essential to diagnose encrusted cystitis early and to provide adequate treatment promptly.