長期臥床高齢者の女性巨大尿道結石の2例

Abstract

長期臥床高齢者で, 膀胱結石が下降して嵌頓した女性尿道結石を2例経験した.1例は婦人科の内診の際に前膣壁から腫瘤を触れ, 1例は寮母がオムツ内の肉眼的な血尿に気づいたことが発見の端緒であった.痴呆, 精神障害, 麻痺があると症状を自覚できなかったり訴えることができず, 診断の遅れが膀胱結石の成長, 女性では珍しい尿道への嵌頓につながったものと推測された.長期臥床者の尿路感染症や血尿を診る際, 結石の可能性を念頭に置くことが早期診断のために必要と考えられた

A 78-year-old female suffering from a cerebral infarction and subdural hematoma was referred to us due to a hard mass in the anterior vaginal wall which was disclosed during gynecological examination. An abdominal X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) showed that a large spindle-shaped stone, 60 x 42 mm in size, was impacting the urethra. It was impossible to catheterize the urethra. The stone gradually projected through the external urethral meatus and was removed by grasping and drawing with forceps. Another 83-year-old female with senile dementia was referred to us because of macrohematuria. An abdominal X-ray and CT showed the presence of two oval bladder stones, 32 x 24 mm and 30 x 21 mm in size. During a follow-up, one of the stones projected partially through the external urethral meatus and was removed by drawing with forceps. After a week, the other stone impacted the urethra and was removed in the same way. Both women were frail, bedridden institutionalized elderly with severe dementia, and their urination had been managed with diapers for years. As the proportion of elderly people in Japan rapidly increases, female urethral stones migrating from the urinary bladder, once very rare, may increase in number, to which we must pay attention.