無機能骨盤腎の巨大腎盂と結腸導管を用いてContinent urinary reservoirを作成した総排泄腔外反症の1例  [in Japanese] CONTINENT URINARY RESERVOIR USING DILATED RENAL PELVIS OF NON-FUNCTIONING PELVIC KIDNEY IN A GIRL WITH CLOACAL EXSTROPHY  [in Japanese]

1症例は8歳,女児.生後総排泄腔外反症と診断され,小腸瘻,結腸導管のdouble stomaで経過していた。尿禁制獲得を希望し来院.導管造影およびIVP,腎シンチグラムにて右側は高度な腎盂腎杯の拡張を伴う無機能骨盤腎であることが判明した。これまで導管として使用していた結腸成分を脱管状化したものと右無機能骨盤腎の巨大腎盂をもちいてurinary reservoirを作成した。禁制導尿路の作成は,拡張した腎盂前壁を用いMitrofanoff法を応用して行なった。術後経過は良好で,1年半後膀胱容量は350mlまで増加し,1日5回の間欠的自己導尿にてほぼ禁制が保たれている。一般に膀胱容量の増大を目的とした手術には消化管が用いられているが,拡張した上部尿路は選ばれた症例においては有効な生体材料であると思われた。

We performed construction of continent urinary reservoir in an 8-year-old girl with cloacal exstrophy who had double stoma of ileostomy and colon conduit. Preoperative evaluation revealed non-functioning right kidney with severely dilated renal pelvis and calyxes in her pelvis. Urinary reservoir was constructed using detubularized colon segment which had been used as the urinary conduit and dilated renal pelvis of non-functioning pelvic kidney. Using Mitrofanoff's principle, continent catheterizable channel was also made of the anterior wall of the renal pelvis. Postoperative course was uneventful. Reservoir capacity increased to 350 ml one and half year postoperatively and she is almost dry with clean intermittent catheterization 5 times a day. Dilated upper urinary tract is one of the ideal material for bladder enlargement that avoids the complication associated with the use of gastrointestinal tract.