尿道全周を取り囲んだ女子尿道憩室の治療経験

Abstract

症例1は49歳女性で, 腹部超音波検査にて膀胱後壁に接する嚢胞様腫瘤を指摘され, 紹介来院した.排尿後の静脈性腎盂造影の立位像で膀胱下方に造影剤の貯留を認め, 逆行性膀胱尿管造影で尿道周囲に5×5×7.5cmの造影剤の貯留を認めた.MRIでは尿道全周を取り囲むように腫瘤が存在していた.以上の所見から尿道憩室と診断し, 経腟的尿道憩室摘除術および憩室口閉鎖術を施行した.病理組織学的所見では壁は炎症性肉芽組織が大半を占め内面は一部移行上皮で被われていた.症例2は36歳女性で, 第2子の妊娠5ヵ月頃より会陰部痛を認め, 産婦人科にて腟前壁の腫瘤を指摘され, 出産後に紹介来診した.腹部超音波検査で尿道を全周性に取り巻く多房性嚢胞を認め, 排尿時膀胱尿道造影で尿道周囲に3×3×4cmの造影剤貯留が認められた.CT・MRI所見で尿道全周を取り囲んだ憩室が認められ, 症例1と同様の手術を施行した.病理組織学的所見は炎症性肉芽組織を認めるのみであった

We report two cases of female urethral diverticula. A 49-year-old woman (case 1) complained of perineal pain when she voided urine. A 36-year-old woman (case 2) complained of perineal pain. In both cases, intravenous pyerography and urethrography revealed diverticula around their urethra, and we diagnosed them with urethral diverticula which surrounded their urethra by magnetic resonance imaging. We treated them by transvaginal diverticulectomy. Case 2 was successfully treated, but the diverticulum recurred after one year in case 1. There are over 200 reported cases of female diverticula in the Japanese literature, but a urethral diverticulum surrounding the urethra is rare.