成人女性に発生した尿管異所開口術後尿失禁

A case of urinary incontinence following surgery for ectopic ureter in an adult woman

　症例は30歳女性で，立位時にのみ発生する尿失禁を主訴に受診した。19歳時の左重複尿管・尿管異所開口に対する左上半腎切除術の既往があった。精査の結果，以前の手術の遺残尿管が憩室化し，失禁・頻尿の原因となっていたと判明した。遺残尿管切除術を施行し，自・他覚的に失禁は消失した。重複尿管・尿管異所開口の治療術後，下端残存尿管は憩室化し失禁の原因となる可能性があるため，十分に説明を行っておくことが必要と思われた。

　A 30-year-old woman presented with a complaint of intermittent urinary frequency and non-stress urinary incontinence without urgency. She had undergone heminephrectomy for a left duplicated ureter with hydronephrosis of the upper segment of the kidney 11 years earlier. Reevaluation following a year and half of conservative management,revealed a marked dilatation of the residual ureteral stump opening to the urethra,which caused the frequency and incontinence. Surgical excision of the distal ureteral stump with ureterovesiconeostomy of the intact ureter was performed successfully and she is now free from urinary symptoms. A residual ureteral stump retained in the bladder neck or urethra may develop unexpected incontinence or recurrent urinary tract infection. We should inform the patient about this posibility as late complication following ectopic ureter surgery when its lower segment is not completely removed.