術中明らかな直腸損傷を認めずに発症した腹腔鏡下前立腺全摘除術後の尿道直腸瘻の1例

Abstract

67歳男性.患者は健診にてPSA高値を指摘され, 著者らの施設へ紹介となった.前立腺生検にて前立腺癌, 臨床病期T2N0M0と診断し, 腹腔鏡下前立腺全摘除術を施行した.術中に明らかな直腸損傷を認めず, 経過良好で術後7日目に退院となったが, 術後11日目の尿検査にて糞便の混入を認め, 再入院となった.逆行性尿道造影にて尿道直腸瘻孔を認め, 尿道カテーテルを留置し, 絶食で中心静脈栄養とした.その後, 高圧酸素治療を開始したところ, 入院15日目に瘻孔の閉鎖が確認され, 入院26日目に尿道カテーテルを抜去した

Urethrorectal fistula is a relatively rare disease. The most frequent cause of acquired urethrorectal fistulas is known to be iatrogenic complications, such as rectal injuries during the prostate operations. Rectal injuries are usually noticed during the operation and the majority can be repaired in situ. We report a case of late-onset urethrorectal fistula that lacked obvious rectal injury during the operation. Ischemic change or heat denaturation of rectal wall may be the potential cause of the present urethrorectal fistula.