排尿時経直腸的超音波断層法が診断に有用であった前立腺結石による排尿障害の1例

Abstract

症例は69歳男で, 排尿困難を主訴とした.尿流量検査で苒延性排尿障害を認め, 経直腸的超音波断層法(TRUS)では前立腺肥大は認めず, 前立腺結石症と診断した.逆行性尿道造影では明らかな尿道狭窄は認めず, 確定診断のためvoiding TRUSを施行した.膀胱頸部の堤防状隆起もなく, 開大も良好であったが, 精阜部の上下に前立腺結石を認め, その部分での動きが悪く, 開大不良と判定した.手術所見で尿道狭窄はなく, 前立腺両側葉による圧排もなかった.精阜部直上及び両側下方を切除し多数の黄黒色前立腺結石を認め, 経尿道的に前立腺結石を中心に切除した.術後排尿障害は改善した

A 69-year-old patient, who had been treated using alpha 1-blocker for benign prostatic hyperplasia (BPH) at another clinic, visited our clinic due to persistent difficulty in urination. Total International Prostate Symptom Score (IPSS) was 32 points and quality of life (QOL) index was 5. Uroflowmetry demonstrated maximum urinary flow rate and average urinary flow rate to be 9.2 ml/sec and 5.1 ml/sec, respectively, with 3 ml of residual urine volume. Transrectal ultrasonography (TRUS) revealed prostatic stones but not BPH. Retrograde urethrography demonstrated nothing abnormal other than prostatic stones. TRUS at voiding phase using linear probe (voiding TRUS) revealed poor opening of the urethra surrounded by prostatic stones. As a result, the cause of urinary disturbance was diagnosed to be due to urethral obstruction caused by prostatic stones, and transurethral resection of prostatic tissue with stones was performed. Postoperatively, IPSS decreased to 10 points and QOL index to 2. Maximum urinary flow rate also improved to 18.1 ml/sec and mean urinary flow to 8.4 ml/sec. Thus, voiding TRUS is likely the best urodynamic test for clinical use in determining the etiology of obstruction at posterior urethra.