ミューラー管嚢胞と射精管閉塞を原因とする慢性血精液症に対する経尿道的内視鏡手術

Abstract

1年以上持続, 反復する慢性血精液症3例に経尿道的内視鏡手術を行った.3例中2例はミュラー管嚢胞, 1例は射精管閉塞が各々の血精液症の原因であった.3例とも2～3回の射精以降は血性精液は消失し, 射精時痛があった2例は術後数ヵ月で射精時痛は消失していた.1.3～3.5年間の経過観察では再発は認められていない.又, 術後合併症もなかった.本症の治療法として経尿道的内視鏡手術は有効であった.この治療法を安全に行うには, 経直腸的超音波監視下での手術操作と精管切開又は嚢胞穿刺による嚢胞や射精管腔への色素の注入が推奨される

Between June 1997 and September 1999, we performed transurethral unroofing (TUUR) in three patients with hematospermia that recurred repeatedly for one year or more. Patient 1 (48 years old) and Patient 2 (59 years old) were diagnosed as having mullerian duct cysts that communicated with the left ejaculatory duct, and Patient 3 (36 years old) as an ejaculatory duct obstruction with the right ejaculatory duct dilation. A mixture of water-soluble contrast medium and indigocarmine blue dye was injected into the cysts and the ejaculatory duct cavity after incision of the vas deferens in Patients 1 and 3, and by cyst puncture under transrectal ultrasound (TRUS) guidance in Patient 2. Then the urethra was incised between the bladder neck and the verumontanum using a Collins' hot knife electrode, and spouting of the dye from the incision was judged to indicate successful unroofing. In Patient 2, safe and simple TUUR was possible by identifying the cyst location and its distance from the knife electrode under TRUS guidance. Hematospermia resolved after surgery in all three patients and there has been no recurrence for 1.3-3.5 years (mean: 2.6 years). Thus, TUUR was effective for treating chronic hematospermia caused by mullerian duct cyst and ejaculatory duct obstruction. For safe and reliable performance of this treatment, TRUS guidance and injection of the dye into the cyst and ejaculatory duct cavity can be recommended.