腎盂腫瘍に対する尿管引き抜き術後に発生した膀胱腟瘻の1例

Abstract

64歳女.腹圧性尿失禁を主訴とした.2年前に右腎盂腫瘍に対して右腎尿管全摘除術(尿管引き抜き術)を受けた.術後より間欠的に尿失禁が出現し, 術後化学療法と並行して失禁に対して保存的治療を受けるも改善しなかった.今回施行したPad testは56gと重症であり, chain cystographyの側面像にて膀胱後壁から腟への造影剤漏出を, 膀胱鏡にて右尿管口跡に直径約2mmの瘻孔を認め, 膀胱腟瘻の診断で経腟的瘻孔閉鎖術を施行した.術後14日目のカテーテル抜去後, 切迫性尿失禁が出現したが, 経過と共に消失し, 術後6ヵ月後の膀胱鏡, CTにて瘻孔や腫瘍の再発は認めていない

A 64-year-old woman underwent right nephroureterectomy of the ureter by the intussusception method under the diagnosis of right renal pelvic tumor in December 2001. Stress incontinence appeared postoperatively, and though conservative treatment was performed, it did not improve. The result of the pad-weighting test was 56 g indicating serious incontinence. In chain cystography, contrast media from the posterior wall of the urinary bladder to the vagina leaked out by the lateral view, and in cystoscopy, a fistula of about 2 mm in diameter was recognized in the right ureteral orifice trace. Under the diagnosis of vesicovaginal fistula, we performed transvaginal repair of the vesicovaginal fistula in November 2003. The urethral catheter was removed on the 14th postoperative day. After removal of the urethral catheter, urge incontinence was recognized, but it improved gradually. The recurrence of fistula and tumor has not been recognized at present.