恥骨後式根治的前立腺全摘除術後の膀胱尿道吻合部不全に対する尿道カテーテル牽引によってさらなる吻合部解離を来たした1例

Abstract

76歳男性.患者は近医にてPSA高値を指摘され, 著者らの施設へ紹介となった.前立腺生検の結果, 前立腺癌, 臨床病期T1cN0M0と診断し, 恥骨後式根治的前立腺全摘除術を施行した.術後, 膀胱尿道吻合部不全を認め, 尿道カテーテルを軽く牽引したところ, 30mlのバルーンが落ち込むほどに吻合部が大きく解離した.そこで, 解離部を60mlのカフの22Fr尿道カテーテルに変更し, 牽引せずに膀胱内留置した結果, 吻合部の治癒が得られた.カテーテル抜去2ヵ月後に吻合部の尿道狭窄を認めたが, 内尿道切開術にて排尿困難は消失した

A 76-year-old man with clinical stage T1c adenocarcinoma of the prostate underwent radical retropubic prostatectomy. After a cystography on postoperative day 7 demonstrated minimal contrast extravasation, gentle catheter traction was performed. However, a cystography on postoperative day 21 showed a displacement of the catheter out of the bladder due to more significant anastomotic rupture. The catheter was preserved without catheter traction for two months. A cystography revealed complete healing of anastomosis without extravasation. This case suggests that catheter traction for anastomotic leakage should be performed carefully because of a potential risk of further anastomotic leakage.