尿管憩室の1例

Abstract

A 46-year-old female was first seen at the out-patient department of urology on August 19, 1968, being referred from her family physician because of lumbar pain and abnormalities of pyeloureterogram. Physical, examination revealed no abnormality and laboratory data were within normal range. Excretory pyelogram demonstrated normal-looking pyelocalyceal system on both sides with an unusual structure extending upwards just laterally to the ureter in the upper third of the right ureter (Fig. 1). Retrograde pyelogram showed a pouch-like structure from the right ureter, originating at the level of sacro-iliac joint (Fig. 2), and a diagnosis was made as diverticulum of the right ureter. At exploration of the right ureter, the ureter was found to be partly duplicated in such a way as running in pararell within the common ureteral sheath. One of the two ureteral structures was noted to have a blind end where no rudimentary kidney was recognized, and conjoined to the original ureter at 5cm above the level of the iliac vessels (Fig. 3). The diverticulum was amputated from the ureter, and the opening was primarily closed with three interrupted sutures of 000 catgut. Postoperatively, the patient did well and left the hospital in three weeks. Removed specimen was a ureter-looking structure of 5cm long with normal caliber. Complete lumen was recognized through the entire length (Fig. 4). No tumor or hemorrhage was seen inside the diverticulum (Fig. 5). Histologically, the wall of diverticulum comprizes transitional epithelium, complete three layer of smooth muscle and periureteral sheath of connective tissue. There is slight edematous change in the submucosa but no inflammatory process (Fig. 6). Excretory pyelography taken on the 10th postoperative day showed satisfactory excretion and drainage without any evidence of urinary stasis or extravasation (Fig. 7).