対側停留精巣と同側腎無形成を伴った中腎管遺残の1例

Abstract

30歳男性。患者は不妊症を主訴に近医を受診, 無精子症を指摘され, 著者らの施設へ紹介受診となった。妻には産婦人科的な異常を認めず, 精査の結果, 骨盤内精管欠損による閉塞性無精子症を疑い, 手術が行われた。術中所見では右側の停留精巣および腎無形成を伴った中腎管遺残が確認され, crossed vasovasostomyは困難と判断し, 手術を終了した。その後, 文献的に考察し, 右は停留精巣による精子形成不全, 左は中腎管遺残が不妊症の原因と考え, TESEを行った結果, 正常精子を認めたため, 卵細胞質内精子注入術を施行した。

A 30-year-old man with azoospermia underwent an examination for infertility. He had a history of right orchiopexy due to cryptorchism. Radiological examinations showed an absence of the left kidney and the left seminal vesicle. A testicular biopsy revealed normal spermatogenesis in the left testis, but no spermatogenesis in the right testis. The right vasograph demonstrated obstruction of the vas deferens at the inguinal region. The left vasograph showed that the left vas drained into a cystic lesion, which then drained into the bladder neck. The left ureter was connected to this cystic lesion. The final diagnosis was a persistent mesonephric duct which was open to the bladder neck. The pathogenesis of the persistent mesonephric duct combined with the ectopic opening of the ureter and the vas deferens is discussed. The patient was treated by testicular extraction of the testicular sperm, and intracytoplasmic sperm injection.