過活動膀胱と腹圧性尿失禁の症状を呈した胃癌膀胱転移

Metastatic bladder cancer presenting with symptoms of overactive bladder and stress urinary incontinence : A case report

　59歳女性．10か月前から頻尿，混合性尿失禁が悪化し，薬物療法で改善せず紹介された．前医での尿沈渣，細胞診は異常なく，排尿日誌で最大1回排尿量が100mLと減少していた．膀胱鏡で頂部に外からの浸潤所見を認め，膀胱生検で7年前に手術した胃癌の膀胱転移と診断された．膀胱転移は比較的まれだが，薬剤抵抗性・進行性の過活動膀胱症状では，尿所見が正常でも膀胱鏡や超音波検査を行う意義がある．

Abstract

A 59-year-old woman was referred to us as symptoms of overactive bladder and stress urinary incontinence worsened in ten months despite pharmacotherapy. Urinalysis and urine cytology were normal, and her voiding diary showed that maximum voided volume was 100mL. Cystoscopy revealed an invasive lesion at the bladder dome. Abdominal CT and MRI showed broadly thickened bladder dome wall and bilateral hydronephrosis. She had a history of gastrectomy due to gastric cancer seven years earlier and transurethral bladder biopsy confirmed bladder metastasis of gastric cancer. Even when urine examination is normal, cystoscopy or abdominal ultrasound may be recommended in patients with refractory overactive bladder symptoms (Rinsho Hinyokika 73 : 409-412, 2019).