異常血管による下部尿管通過障害

Abstract

Aberrant blood vessels such as umbilical, uterine and vesical arteries may compress the lower ureter at the juxtavesical portion, resulting in stasis of the upper urinary tract. Urographically this condition can show the similar findings as the stenosis of the ureterovesical junction. So this disease was poorly diagnosed and only thirty cases have been reported since Hyams described the first case in 1929. But it may become more common lesion, if the differential diagnosis from the lower ureteral stenosis is taken into consideration. We wish to present two cases with obstruction of the juxtavesical ureter due to the umbilical and uterine artery, respectively. First patient was a 13-year-old boy complaining of albuminuria. Another was a 38-year-old woman suffering from left flank pain. Excretory urograms showed juxtavesical ureteral obstruction with hydroureteronephrosis. Ureteral catheter could be introduced into the renal pelvis without difficulties in both cases. Surgical exploration revealed that right lower ureter was obstructed at the juxtavesical portion by the pulsatile umbilical artery in the first case and that left juxtavesical ureter was obstructed by the anterior and posterior branches of the uterine artery in the other case. Since the dilated ureter did not decrease in size after division of the aberrant vessel, ureteroneocystostomy was performed in both cases. Postoperative course was uneventful. Postoperative excretory urograms showed almost no improvement of hydroureteronephrosis three months later in the first case and one month later in the other case. We also discussed its etiology, incidence, diagnosis, treatment and prognosis in reference to Japanese and foreign literatures.