尿管腫瘍の診断

Abstract

Twenty-seven tumors of the ureter were experienced during 17 years, 1960 to 1976. Diagnostic problems of the ureteral tumor were discussed in this paper. Clinical symptoms were gross hematuria in 23 cases (35%), pain in 10 cases (37%), mass in 3 cases and extra-urinary symptom in 6 cases. Cystoscopic examination revealed a tumor protruding from the ureteral orifice in 5 cases, bulging orifice in one case and hemorrhage from the orifice in 2 cases. Therefore, 7 of 27 cases (26%) showed the findings strongly suggesting the ureteral tumor. These seven tumors were all located in the lower third of the ureter. Gross hematuria from the orifice was observed in 4 cases, all being the tumor located in the upper third of the ureter. Ureteral catheterization was performed in 17 cases and 13 (76%) showed obstructive finding. Chevass-Mock's sign was noted in 6 and Marion's sign in 3. These findings specific to the ureteral tumor seen in 94% of the cases are diagnostically significant. Urography showed filling defect of the ureter in 18 of 27 cases (67%) and urinary obstruction in 2. Dilatation of the ureter and renal pelvis above the site of the tumor was seen in 19 of these 20 cases. Three had dilatation of the ureter just distal to the tumor. Six patients showed non-visualizing kidney and 2 (7%) normal ureteropyelogram. Angiography was performed in 8 cases, and 2 (25%) showed stain of the tumor vessels. Nine of 27 cases (33%) had tumor occurring in the renal pelvis or the bladder, 4 being found simultaneously. Three ureteral tumor developed after treatment of the bladder tumor, 3 years and one month, seven years and 5 months, and 8 years and 2 months respectively. For the early diagnosis of the ureteral tumor, cystoscopy has to be performed immediately after the onset of the gross hematuria. The state of the ureteral orifice and the ureteral urine must be checked. Ureteral catheterization should be performed in order to detect the obstruction and collect the ureteral urine. Urography should be followed to demonstrate the filling defect and the dilatation of the upper urinary tract. Simultaneous presence of the uroepithelial tumor must be always kept in mind, and the follow-up study of the upper urinary tract after treatment of bladder tumor is required.