腹圧性尿失禁の既往をもち診断困難であった医原性尿管膣瘻の1例

Abstract

A 45-year-old woman was admitted to our hospital with a chief complaint of stress urinary incontinence. She had undergone simple hysterectomy due to myoma uteri at another hospital. X-ray examination and ultrasonography revealed a hydronephrosis on the right side after the surgery, which was improved immediately without intervention. She was diagnosed as having stress incontinence according to the history, findings of frequency/volume chart, 1-hour pad test, cystoscopy, drip infusion pyelography, magnetic resonance imaging and so on. Periurethral injection with non-animal stabilized hyaluronic acid/ dextranomer was performed. Incontinence was improved, but was not cured completely. After indigo carmine intravenous injection, cystoscopy was performed but no urine flow was noted from the right ureteral orfice. At the transvesical investigation, blue fluid was found at the vagina, and she then was diagnosed as having right ureterovaginal fistula. She underwent ureterovaginal fistula repair and reimplantation of the right ureter, and her incontinence was cured. To our knowledge, this is the first case of ureterovaginal fistula associated with stress incontinence.