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Abstract
63歳,男性.騎乗型打撲による尿閉と外尿道口からの出血にて受診.球部尿道に約1cmの断裂を認め,膀胱痩を造設した.二期的にエコーガイドを併用し内視鏡的尿道形成術を施行した.術後の再狭窄に対しては2回の経尿道的瘢痕切除術を施行した.術後の排尿時膀胱尿道造影では狭窄を認めず,尿失禁・性機能障害もなく自排尿可能となる.近年,内視鏡器具の進歩に伴って尿道損傷に対して開放術より容易で,低侵襲で,再手術可能な内視鏡的尿道形成術が行われている.今回併用したエコーガイドの有用性は断装部の遠位端と近位端を同一平面に描出することによって,正確に穿刺し,ガイドワイヤーを挿入でき,直腸損傷や偽尿道の危険がなく,本来の尿道走行を再建出来ることである.
We report a case of 63-years-old man with a chief complaint of urinary retention and urethral meatal bleeding due to straddle injury. Urological examination revealed proximal bulbous urethral disruption with 1 cm gap, and then cystostomy was placed. Afterwards, urethral disruption was treated by echo guided endoscopic urethroplasty. Transurethral resection of scar tissue was performed twice for postoperative urethral stricture. Postoperative voiding cystourethrography revealed no urethral stricture. The patient voids well without urinary incontinence and erectile dysfunction. Recently, endoscopic urethroplasty, which is easy, minimally invasive, and repeatable in comparison with open urethral reconstruction, has been frequently performed for urethral disruption as endoscopic instruments functionally develop. Echo guided image in the present case is so useful that proximal and distal end of urethral disruption can be shown in same plane, indicating that primary urethral tract can be reconstructed without injury of rectum and urethra.
Journal
- The Japanese Journal of Urology [List of Volumes]
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The Japanese Journal of Urology 98(5), 727-730, 2007-07-20 [Table of Contents]
The Japanese Urological Association
