夜尿症を主訴とした小児先天性尿道狭窄症の3例

Abstract

症例1は8歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄があり, 両側II度のVURを認めた.内視鏡的切開術を施行し, 術後3ヵ月で遺尿症を再発した.再度切開術を施行し, 外尿道括約筋のすぐ遠位に膀胱を充満させると強調されるリング状狭窄を認めた.症例2は7歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄を認め, 左側にII度のVURを伴っていた.尿道狭窄症と診断し内視鏡的切開術を施行した.膀胱内には軽度の肉柱形成が存在し, 括約筋遠位に巻き貝状の狭窄を認めた.術後4ヵ月でVURは消失していた.症例3は5歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄を認め, VURはなかった.内視鏡的切開術を施行し, 膀胱内には軽度の肉柱形成が存在しており, 括約筋遠位に複数の不完全なリング状狭窄を認めたため切開した

We report three cases of congenital urethral stricture in boys. They were 8, 7 and 5 years old. They complained of enuresis both day and night. Voiding cystography revealed bulbar narrowing (Cobb's Collar) in all cases, and vesico-ureteral reflux (VUR) occurred in two cases (three ureters). Endoscopically this lesion showed ring-form stenosis just distal to the urethral sphincter, and incised by using an infantile urethrotome. After the operation, VUR resolved in two ureters and improved in one. In all cases, daytime enuresis resolved dramatically, and night enuresis became controllable. Congenital urethral stenosis in boys is an important clinical entity in pediatric urology, and is not such a rare disease.