Geriatric ureteropelvic junction obstruction: the possible role of an arteriosclerotic lower pole branch of renal artery: report of two cases

Abstract

症例1は83歳女, 主訴は左側腹部痛と高熱である.左尿管カテーテル留置し, 抗生剤投与とエンドトキシン吸着療法施行後, 手術にて腎下極を支配する動静脈による腎盂尿管移行部の圧迫が左水腎症の原因であると判明, これらの切断にて閉塞を解除した.症例2は82歳男, 主訴は右側腹部痛で, 既往歴に高血圧があった.腎血管造影にて腎下極への動脈の圧迫による水腎症が原因と判明.この動脈の切断と腎盂形成術にて軽快.2例とも長期に高血圧症を患い, 軽度から重度の動脈硬化を呈していた.動脈硬化による腎盂尿管移行部の締め付けが, 高齢者に発症し, 増悪する水腎症の一因と考えられる

An 83-year-old woman presented with left flank pain and high grade fever. After left ureteral catheterization and intensive chemotherapy with hemoperfusion, surgical exploration revealed the lower pole branches of the renal vessels were obstructing the ureteropelvic junction (UPJ), and dissection of the vessels released the obstruction. An 82-year-old man presented with right flank pain. Angiography demonstrated UPJ obstruction caused by the lower pole branch of the renal artery. Arterial dissection with dismembered pyeloplasty resulted in improvement of obstruction. In both cases, the patients had a long history of hypertension with mild to severe arteriosclerosis. Arteriosclerosis associated with fixation of the UPJ, may be one of the important factors leading to progressive hydronephrosis in geriatric patients.