過活動膀胱症状を呈した子宮頸癌

Two cases of cervical cancer presenting with overactive bladder symptoms

症例1：76歳女性。頻尿，肉眼的血尿を訴え前医受診。尿路精査は異常なく，過活動膀胱の抗コリン薬を内服。2年後尿失禁が悪化し，当科紹介。膀胱鏡で後壁の圧迫挙上，内診で性器出血と子宮頸部の腫瘤（長径11cm）を認めた。症例2：67歳女性。混合性尿失禁と頻尿で抗コリン薬を処方され，半年後当科紹介。CTで長径9cmの骨盤内腫瘤を認めた。両患者は子宮頸癌Ⅲb期と診断され，同時併用化学放射線療法で下部尿路症状は消失した。

Case 1：A 76-year-old woman visited a local general hospital complaining of urinary frequency and“macroscopic hematuria”. Detailed examination of the urinary tract showed no abnormal findings, and antichorinergic drugs for overactive bladder were prescribed. Two years later, she was referred to our department due to aggravated urinary incontinence. Cystoscope revealed massive elevation of the posterior vesical wall. Vaginal examination revealed an easily-bleeding mass（11 cm in the longest diameter）in the uterine cervix. Case 2：A 67-year-old woman suffering from mixed incontinence and urinary frequency was prescribed anticholinergic drugs for six months. She was then referred to our department and underwent CT scan to evaluate continuous pyuria and microscopic hematuria. An intrapelvic mass, 9 cm in the longest diameter was found. Both patients were diagnosed as stage Ⅲb cervical cancer, and their lower urinary tract symptoms disappeared after concurrent chemoradiation. An intrapelvic mass, including cervical cancer, must not be overlooked in patients with intractable overactive bladder symptoms.