Inflammatory bowel disease (IBD)と尿路男性生殖器合併症との関連

Abstract

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that may often involve organs other than those of the gastrointestinal tract. We investigated retrospectively the frequency, diagnosis and treatment of urinary and male genital complications of CD and UC. From February 1998 to July 2007, 93 patients with CD and 75 patients with UC consulted our department for urinary and male genital complications. Thirty, 19 and 16 of the 93 patients with CD were diagnosed as having fistulas to the urinary and male genital systems, urolithiasis and hydronephrosis, respectively. Fifteen, 14 and 13 of the 75 patients with UC were diagnosed as having urolithiasis, urinary tract infection (UTI) and lower urinary tract symptoms (LUTS), respectively. Fistula to the urinary and male genital systems in CD occurred more often in men. In 22 CD patients who had undergone surgical operation and were definitively diagnosed as fistula, the positive rate of cystogram (CG) was 38.1% (8/21). They presented with pyuria (10 cases), pneumaturia (7), hematuria (7), fecaluria (2) and urorrhea (2). Cystoscopy was performed in 20 patients. Fistula opening in the urinary bladder was found in only 2 patients. Other findings in the bladder were edema (14 cases), redness of mucosa (6) and debris (3). Hydronephrosis in CD occurred in 16 patients. Placing a percutaneus nephrostomy (PNS) or ureteral stent was performed in 11 patients and surgical therapy was performed in 12 patients. Only two of the 34 patients with urolithiasis (CD 19, UC 15 cases) underwent ESWL and/or TUL. Almost all patients with UTI in UC were treated with antibiotics and improved, but one patient died from Fournier’s Gangrene due to erirectal abscess.