経尿道的切除を行った精嚢腺嚢胞の1例

Abstract

40歳男性.患者は排尿困難を主訴に近医を受診, 超音波検査にて膀胱後面の嚢胞状腫瘤を指摘され, 著者らの施設へ紹介入院となった.入院時, 血清PSA値は測定感度以下で, TRUSにて前立腺膀胱移行部から膀胱後面にかけ5.8×5.7×4.7cmの嚢胞状腫瘤が認められた.更にMRIでは腫瘤はT1にて低信号, T2にて著明高信号を呈し, 精管造影では嚢胞が造影され, 両側の精管および精嚢腺が嚢胞により著明に右側へ圧排されていた.以上より, 精嚢腺嚢胞と診断し, 超音波ガイド下経会陰的嚢胞穿刺, 嚢胞内エタノール注入による硬化療法, 経尿道的嚢胞壁切除術を施行した.その結果, 病理組織学的に悪性所見は認めず, 術後4ヵ月経過現在, 逆行性射精を認めるも, 排尿障害は軽快した

A 40-year-old man with dysuria was referred to our department on November, 18, 2004. A transabdominal ultrasonography revealed a cystic mass arising from his bladder neck. Computed tomography and magnetic resonance imaging revealed the cyst to be homogeneous and ovally shaped with a clear margin. Bilateral vasography showed the compression of the left seminal vesicle by the cyst and there was communication between the cyst and the left seminal vesicle for diagnosis of the seminal vesicle cyst, percutaneous needle aspiration was performed. The aspirated fluid included microscopical spermatozoa and proved negative for cytology. Absolute ethanol was injected into the cyst and transurethral unroofing of the cyst was performed on January 14, 2005. The prostate was resected until we reached into the cyst.