前立腺生検時における膀胱鏡検査の臨床的意義

Abstract

前立腺生検時における膀胱鏡検査の臨床的意義について検討した.1)膀胱鏡検査では458例中43例(9.3%)で何らかの異常所見が発見され, その内訳は膀胱癌11例(2.4%), 膀胱結石13例, 膀胱ポリープ5例, 尿道ポリープ7例, 尿道狭窄6例, 尿管瘤1例であった.2)膀胱癌の合併率は前立腺癌では201例中5例(2.5%), 前立腺肥大症では257例中6例(2.3%)と有意差はなかった.3)膀胱鏡検査で偶然発見された膀胱癌はすべて早期癌でTUR-Btが行なわれ, 他の疾患に対しても適切な治療が行なわれた.以上, これらのことからも, 前立腺生検時の膀胱鏡検査は臨床的に意義があるものと考えられた

The clinical significance of cystoscopy in patients with benign prostatic hyperplasia or prostate cancer remains open to discussion. We have always performed cystoscopy with prostate biopsy and have discovered bladder cancer in some patients. The present study investigated the clinical significance of performing cystoscopy with prostate biopsy. Subjects were 458 patients who underwent cystoscopy and ultrasound-guided transrectal prostate biopsy from January 1998 to December 2004. Mean age of subjects was 71.3 years (range, 52-93 years). Prostate biopsy was performed modified Eskews systematic 5-region prostate biopsy (12 core). Some abnormalities were found in 43 of the 458 patients (9.3%). Among these 43 patients, bladder cancer was found in 11 patients (2.4%), and transurethral resection bladder tumor (TUR-Bt) was performed on all 11 patients. Pathological staging of bladder cancer was pT1 and G2 in all cases. Bladder stones were seen in 13 patients (2.8%), benign bladder tumor in 5 patients (1.1%), urethral polyp in 7 patients (1.5%), urethral stenosis in 6 patients (1.3%) and ureteral stones associated with ureterocele in 1 patient (0.2%). Appropriate examinations and treatments were performed for all cases. Cystoscopy may be needed at the time of prostate biopsy because: the above-mentioned abnormalities were first discovered on cystoscopy; and the frequency of bladder cancer was 2.4% for the total patient population, and endoscopic surgery was performed.