脊髄空洞症に合併した膀胱結石

A large bladder stone caused by syringomyelia

　症例は52歳男性。排尿困難を主訴に受診。初診時KUB上，膀胱内に75×68mmの大きな膀胱結石および超音波で軽度の両側水腎症を認めた。既往に脊髄空洞症手術歴があり，仙骨領域の温痛覚の低下および下肢筋力の低下を認めた。受診時排尿状況は尿失禁であった。粘膜麻酔下に振動波砕石装置（リソクラスト^(R)）を用い，経尿道的に破砕した。手術時間は221分，摘出重量は131gであった。振動波砕石装置を用いた砕石術の本邦報告例では本症例は最大のものである。

A 52-year-old man visited our hospital because of dysuria. He had a history of syringomyelia and a surgical operation of subarachnoidal shunt drainage 20 years before. Physical examination revealed loss of pain and temperature sensations in sacral area and weakness in muscle strength of the lower extremities. A large bladder stone in size of 75×68mm was found on KUB,with mild bilateral hydronephrosis detected by the ultrasound examination. Under local anesthesia,endoscopic lithotripsy was performed using a pneumatic lithotrite（LithoClast^(R)）. The operation lasted 221minutes,and the stone fragments weighted 131g. In Japanese literature,it was the largest bladder stone ever successfully disintegrated by a pneumatic lithotrite.（Rinsho Hinyokika 60：413-415,2006）