外傷を契機に発見された成人異所性尿管瘤の1例

Abstract

26歳男.サッカーで左背部打撲後, 腹部痛が出現した.CTで後腹膜腔に巨大な嚢胞性腫瘤とその内部に尿管と考えられる索状物を認めた.膀胱鏡検査では左尿道管～膀胱頸部の膨隆と前立腺部尿道の膨隆下端に尿管口を認めた.RPを施行したところ, 左上半腎所属尿管による膀胱への圧排像を認め, 左上半腎所属尿管は外側に圧排偏位し, 水腎症を呈していた.カテーテルを留置し保存的に経過観察した.ドレナージにより腎機能は改善した.その後, 左上半腎所属尿管に対して経尿道的異所性尿管瘤切開術を施行した.術後1ヵ月, VURを認めるものの左水腎症は改善し, 術後7ヵ月の現在, 排尿障害, 尿路感染は認めていない

We report a case of ectopic ureterocele in a male adult found during examination of a traumatic injury. A 26-year-old man sustained a blow to his left back during a football game and was admitted to the hospital with a complaint of abdominal pain. The computed tomographic scan showed a huge cystic mass in the retroperitoneum. A cystoscope revealed a large bulge from the left ureteral orifice to the bladder neck and another ureteral orifice distal to the bulge. Retrograde pyelography revealed an ectopic ureterocele showing a complete duplication, a lateral deviation of the left ureter and a bladder deviation to the right. An ectopic ureteral orifice was opening in the posterior urethra. An ureteral catheter inserted into this orifice revealed a dilated left ureter from the upper half of the kidney. Because the function of left upper of kidney was maintained, a transurethral incision was performed. Vesicoureteral reflux remained, but the postoperative course was uneventful. We discuss 11 cases of ectopic ureterocele in male adults including this case.