水腎症を呈した尿管・膀胱マラコプラキアの1例

Abstract

70歳女.発熱を主訴とし, 急性腎盂腎炎の診断がなされ, 抗生物質の投与で経過観察されていたが腫瘤性病変に消退傾向が認められず悪性腫瘍が疑われ, 精査加療目的のため当科入院した.診断の結果, 悪性腫瘍を否定できず, 脊椎麻酔下で経尿道的膀胱粘膜生検及び膀胱腫瘍切除術を施行した.病理所見では水腎症を呈した尿管・膀胱マラコプラキアと診断された.術後14日後右水腎症の改善は認められず, ステント留置状態で退院となり現在経過観察中である

A 70-year-old woman visited a nearby physician with a chief complaint of fever and was admitted to a hospital with a diagnosis of acute pyelonephritis. After discharge, pyuria persisted and examination revealed an intravesical solid tumor. The patient was referred to this department for close examination and treatment. The right kidney was hydronephrotic. The intravesical tumor that was resected was solid yellowish-white and ranged from the neck of the uterus to both ureteral orifices. In addition, a grain-sized tumoral lesion, was found in the lower part of the ureter and was also resected. There was sclerotic thickening localized to the right intramural ureter, which had a slightly edematous interior. This was considered to be the cause of the hydronephrosis and a ureteral stent was put in place. Pathological diagnosis was given as malacoplakia. With this case, placement of a ureteral stent was chosen based on the findings of a minimal ureteral lesion, a narrow area of scarring in the intramural ureter as a probable cause of hydronephrosis, and a judgement of mild obstruction. A stent is less invasive for patients, but consideration should be given to urinary infection due to long-term placement recurrence of malacoplakia due to the increased risk of infection, and trouble with periodical exchanging of catheters due to aggravated scarring. Absence of pyuria or signs of recurrence after seven months' placement suggests that use of the stent was the best method.