両側水腎症をきたした膀胱マラコプラキアの1例

Abstract

頻尿を訴えた63歳女で, 画像診断は膀胱後壁の結節状腫瘤による膀胱尿管移行部狭窄に起因する両側水腎症を明らかにした.膀胱鏡検査で三角部に黄白色腫瘤を認めた.両側経皮的腎瘻造設術を行った.膀胱腫瘍の生検によりマラコプラキアと診断し, 薬物療法を行ったが, 尿管膀胱移行部の閉塞状況は改善せず, 両側尿管膀胱新吻合術を行った.組織学的には膀胱三角部及び両側尿管下端には尚マラコプラキアが存在したので, 術後20ヵ月の現在でも薬物療法を続けている

A 63-year-old female with a complaint of pollakisuria was referred to our clinic for the treatment of bilateral hydronephrosis. Ultrasonography, computerized tomography (CT) scan and magnetic resonance imaging (MRI) revealed bilateral hydronephrosis due to stenosis of the vesicoureteral junction, which was caused by a nodular mass on the posterior wall of the bladder. Cystoscopy revealed a yellowish-white mass on the trigone. Bilateral percutaneous nephrostomy for the treatment of chronic renal failure due to bilateral hydronephrosis and transurethral resection of bladder tumor were performed. Histological findings indicated a chronic granuloma with Michaelis-Gutmann body and the tumor was diagnosed as vesical malacoplakia. Oral administration of trimethoprim sulfamethoxazole, bethanecol chloride and vitamin C was done for the conservative therapy of malacoplakia. However, stenosis of the vesicoureteral junction remained. Then, bilateral vesicoureteroneostomy was performed and there was no obvious recurrence of malacoplakia 20 months postoperatively.