恥骨後面腸管癒着を伴う腹圧性尿失禁に対する経閉鎖孔式テープ（TOT）手術

TOT operation was useful in treating an incontinent woman with adhesion of intestine to pubic bone

　65歳，女性。既往歴に1）虫垂切除，2）腹式子宮全摘，3）前後膣壁形成，仙棘靱帯固定，4）高位腹膜閉鎖，膣断端吊り上げ，Burch法。腹圧性尿失禁の再発で受診した。CTで恥骨後面に腸管癒着を認めたため，TVT手術の予定をTOT手術に変更し，合併症なく尿禁制を得た。経閉鎖孔式のTOT手術は，恥骨後式のTVT手術で問題となる腸管損傷，膀胱誤穿刺の危険性を回避でき，複数の骨盤内手術歴のある本例ではよい適応であった。

A 65-year-old postmenopausal woman visited our hospital due to recurrent stress urinary incontinence. She had a history of（1）appendectomy,（2）abdominal hysterectomy,（3）anterior and posterior colporrhaphy with sacrospinous ligament fixation,and（4）abdominal suspension of the vaginal vault with the Burch procedure. Computed tomography revealed adhesion of the intestine to the pubic bone,therefore the planned TVT operation was changed to a TOT operation,with an outcome of complete continence without intra-or postoperative complications. The TOT operation（with a trans-obturator approach）can avoid the risks of bowel injury and bladder perforation that accompany the TVT operation（with a retropubic approach）,and thus is a good choice of operation for stress incontinence with a previous history of pelvic surgery.（Rinsho Hinyokika 60：421-424,2006）