間欠性水腎症を呈した両側多発性尿管ポリープの1例  [in Japanese] BILATERAL MULTIPLE URETERAL POLYPS CAUSING INTERMITTENT HYDRONEPHROSIS : A CASE REPORT  [in Japanese]

尿管ポリープは尿管の良性腫瘍で最も一般的であるものの,その疫学に不明な点は多く,また多発性,両側性の発生はきわめて稀である.今回我々は,間欠性水腎症を呈した両側尿管ポリープ症例を経験したので報告する.症例は8歳男児.右側腹部痛と肉眼的血尿を主訴に前医受診し,超音波検査にて水腎症を指摘された.自然軽快するもののその後同様の症状を繰り返すため当院を紹介受診した.経静脈性腎盂造影および逆行性腎盂尿管造影にて両側上部尿管に約5cmの陰影欠損像を認めた.また,超音波検査では疼痛発作時には明らかな水腎症の増悪を認めた.尿管ポリープによる間欠性水腎症と診断し,症状の明らかな右側の腎周囲を剥離.下方への授動後,約7cmの尿管部分切除および尿管尿管吻合術を施行した.切除組織の病理所見はfibroepithelial polyp(FEP)であった.左側に関しては経過観察していたが.6年後に左側腹部痛と肉眼的血尿が出現したため,同様に左尿管部分切除,尿管尿管吻合術を施行した.切除組織の病理所見は同様にFEPであった.左側術後1年経過し,水腎症や尿管ポリープの再発は認めていない.

We report an unusual case of bilateral ureteral polyps causing intermittent hydronephrosis, which developed extensively in the upper part of ureters. The patient was an 8-year-old male. He had several episodes of gross hematuria with right flank pain. Ultrasonography of the kidney showed mild bilateral hydronephrosis, while this finding was markedly aggravated in association with the onset of pain. Intravenous pyelogram and retrograde pyelogram revealed multiple filling defects in both upper parts of ureters. Since the diseased part of the ureter was wide (about 7cm in length), a segmental resection of the right ureter with mobilization of the right kidney was performed, followed by end-to-end ureteral anastomosis. The pathological diagnosis was fibroepithelial polyps. Regarding the disease of contralateral ureter, no surgical treatment was performed because he had no clinical symptoms. Six years after the surgery, he again developed gross hematuria with left flank pain. Marked dilatation of the left renal pelvis was shown by ultrasonography, which suggested left intermittent hydronephrosis caused by ureteral polyps. He underwent a partial ureterectomy with mobilization of the left kidney for the left ureteral disease. No recurrence of polyps has been observed in the urinary tract since this surgery.