術後19年後に再発を認めた膀胱尿管逆流症の1例

Abstract

21歳男.生後4ヵ月時より尿路感染症を繰り返す為, 2歳時に精査目的で受診したところ, 両側の膀胱尿管逆流症(VUR)と診断で両側VUR防止術が施行された.術後21年目(21歳時)に左下部尿管の拡張が認められ, 発熱も出現した為VCUGを施行したところ左II度のVURが認められた.コラーゲン注入による内視鏡的VUR防止術を予定したが, コラーゲンに対するアレルギー反応が認められ, 手術目的で入院となった.膀胱鏡検査で右尿管口は正常円錐型で, 左尿管口はゴルフボール型を呈していた

A 21-year-old male, who had been operated on for bilateral vesicoureteral refluxes (VURs) with bilateral ureterocystoneostomy (Politano-Leadbetter's method) 19 years before, was admitted to our hospital due to recurrent VUR. Since the former operation, he had undergone voiding cystography (VCUG) twice for two years, and no refluxes were found. Moreover, no evidence of upper urinary tract deterioration was found by either intravenous pyelography (IVP) or renal ultrasound scanning taken the year before this admission. Nineteen years after the operation, the dilation of the left lower ureter was found on IVP and, consequently, he suffered from pyelonephritis. The VCUG revealed the recurrence of left VUR. Because of his allergic reaction to collagen, we again performed left ureterocystoneostomy (Politano-Leadbetter's method). At three months postoperatively, there was no VUR found on VCUG.