経直腸エコー下経会陰穿刺法で治療しえた膜様部尿道断裂

A case of successful treatment with the transperineum insertion under transrectal ultrasonography for the membranous urethral disruption

　症例は51歳，男性。球部から膜様部尿道の完全断裂にて前医を受診した。経尿道的尿道形成術を2度試みられるも成功せず，当院へ紹介された。経直腸エコー下経会陰穿刺法を併用し，経尿道的尿道形成術を施行した。経直腸的エコー下に確認しながら，会陰より刺入した小線源治療用の穿刺針を括約筋の中心へ向けてすすめ，ガイドワイヤーを膀胱へ留置した。ガイドワイヤーに沿って内視鏡で切開し，尿道を形成し得た。

　A 51-year-old man suffered traumatic disruption of the bulbar to the membranous urethra. At the primary hospital,endoscopic urethrotomy was tried twice,but failed. At our hospital,we performed endoscopic urethrotomy under transrectal ultrasonography. First,we infused aired jelly into the urethra and inserted a brachytherapy needle through the perineum to the urethra. We pushed ahead with the needle further to the posterior urethra and inserted a guidewire to the bladder. Then we inserted an endoscopy from the urethral orifice and cut along the guidewire through the posterior urethra,establishing a new connection.