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症例は36歳男性.頻尿,排尿時痛,残尿感および食思不振を主訴に近医受診.抗生剤投与されるも症状軽快せず,当院紹介受診となる.初診時検査で,白血球,好酸球,IgEの上昇を認め,経腹膀胱超音波検査,MRIで膀胱壁の著明な肥厚を認めた.また,膀胱鏡検査では膀胱三角部を除く膀胱粘膜の著明な浮腫状所見を認め,上部消化管内視鏡検査では胃粘膜及び十二指腸粘膜も同様の浮腫状所見であった.確定診断のため膀胱全層針生検を施行し,病理所見では膀胱平滑筋内に著明な好酸球浸潤を認めたため好酸球性膀胱炎と診断.点滴ステロイド療法を開始し,症状軽快,画像上も改善を認めステロイド内服に切り替えたのち退院した., A 36-years-old man with pollakisuria and digestive symptom was referred to our hospital. A blood test showed inclease of serum white blood cell,eosinophil and IgE. Imaging study showed thickening of bladder wall, and endoscopy of bladder and stomach showed severe mucosal edema. Because there was a suspicion of the allergic diseases, we carried out transabdominal needle biopsy of bladder. Because of the pathological finding of severe eosinophilic infiltration into smooth muscle of urinary bladder, we diagnosed a case of eosinophilic cystitis. After that we started up steroid therapy immediately, he was recovering from pollakisuria and digestive symptom.

症例は49 歳女性.左水腎症と骨盤内リンパ節腫大の精査目的で当院紹介.CT・MRI で左下部尿管に造影効果を認める凹凸不整な腫瘍病変を認め,逆行性尿管造影で左尿管の完全閉塞を認めた.自然尿及び洗浄尿の細胞診は陰性であったが,画像所見から左尿管癌と診断し左尿管全摘除術を施行した.病理組織診で尿管子宮内膜症と診断され,術後は合併症なく退院した., A 49-years-old woman with left hydronephrosis was referred to our hospital. Computed tomography and magnetic resonance imaging showed an irregular contrast enhanced mass of the ureter. A retrograde pyelography showed complete obstruction of the left ureter. Cytology of urine and irrigated ureteral urine were both negative for malignamt cells. Left ureteronephrectomy was performed under clinical diagnosis of the ureteral tumor. Pathological examination of surgical revealed endometriosis of the uteter. She was in good health at 6 months after the surgery with no evidence of recurrence.

【目的】水腎症の原因である腎盂尿管移行部閉塞(Uretero-Pelvic Junction Obstruction;UPJO)の病因を形態的に分類し,患者背景,術後の経過との関連性について検討した.【方法】2009年3月から2013年4月までに獨協医科大学越谷病院で施行した腹腔鏡下腎盂形成術(Laparoscopic Pyeloplasty;LPP)38症例について検討した.術中所見とビデオの見直しから以下のように3つの病因に分類した.Type 1:血管による閉塞を有するもの.Type 2:肥厚した被膜が腎盂尿管を包み込むもの.Type 3:硬い被膜に包まれ尿管の屈曲,狭窄を認めるもの.上記病因と術前後における症状,腹部超音波所見および利尿レノグラムを用いて評価した手術成績について比較検討した.【結果】38症例を手術ビデオで見直した結果,Type 1は14例,Type 2は13例,Type 3は11例であった.小児症例はType 1の症例が少なく,Type 2およびType 3が多かった.各Typeでの術後の症状,腹部超音波所見,利尿レノグラムの改善率に有意差はなかった.【結語】UPJOの形態と年齢には関連を認めたが,術後成績には明らかな違いは認めなかった., Background:To analyze the relationship between the etiology of ureteropelvic junction obstruction (UPJO) and surgical outcomes using laparoscopic clear view during pyeloplasty. Method:Total 38 patients who underwent laparoscopic pyeloplasty by Anderson-Hynes technique from 2009 March to 2013 April at Dokkyo Medical University Koshigaya Hospital, were enrolled into the study. According to the structure of the ureteropelvic junction under the laparoscopic view UPJO was divided to 3 types, type 1 (n= 14):vascular causes of ureteral obstruction, type 2 (n= 14):the presence of adhesion around UPJ, type 3 (n= 11):the presence of angulation due to ureteral kinks or adhesion. The relationships between types of UPJO and surgical outcomes were analyzed.Results:Many of pediatric patient were included in type 2 and 3. Types of UPJO were not related to operation time, symptom, abdominal ultrasonography, and results of diuretic renogram.Conclusion:Most of pediatric patients with hydronephrosis had no vascular cause. There are no significant differences between each types and surgical success rate in patients underwent laparoscopic pyeloplasty.

骨盤臓器脱にTVM 手術を施行した51 症例を対象としてUFM, 残尿量,P-QOL,ICIQ-SF 及びIPSSを調査することによりTVM 手術の下部尿路症状,排尿機能とQOL に与える改善効果を評価した.周術期成績と解剖学的改善度は良好であり,IPSS による下部尿路症状の評価では夜間頻尿以外のすべての項目で有意に改善した.またP-QOL を用いたQOL 評価でも有意な改善を示した.本研究では骨盤臓器脱に対してTVM 手術が下部尿路症状,排尿機能,QOL を短期間の評価ながら改善する事を示した.今後は解剖学的治療効果のみでなく,排尿や性機能を含めて長期間評価することが必要と考えられた., The aim of this paper is to describe the perioperativemedical outcome, complications and the improvement ofvoiding function and their quality of life( QOL) in 51 casesof tension-free vaginal mesh (TVM) for the treatment ofpelvic organ prolapse( POP) at our institute. Perioperativemedical outcome and anatomical restoration were good atsix months after the operation. Lower urinary tract symptomand QOL of the patients were statistically much improvedbased on the results of IPSS and prolapse quality oflife questionnaire( P-QOL), except for nocturia. This studyshowed improvement of voiding function and QOL for thefemale POP.Further studies will be needed for a long period not onlythe anatomical restoration but also the voiding and sexualfunction.