両側膀胱尿管逆流を伴った小児外尿道口狭窄

EXTERNAL MEATAL STENOSIS ASSOCIATED WITH BILATERAL VESICOURETERAL REFLUX

　7歳，男児。再発性尿路感染症にて当科に紹介された。静脈性尿路造影は右腎杯の軽度拡張と棍棒状変化，排尿時膀胱造影で外尿道口狭窄および両側高度膀胱尿管逆流を示した。尿流動態検査は，排尿時膀胱内圧の高度上昇と平均尿流量率の低下を示した。両側逆流防止術と外尿道口切開術を施行した。術後，平均尿流量率は著明改善（14ml／秒）した。本症例は外尿道口の形態および病歴から先天性外尿道口狭窄が強く疑われた。

A 7-year-old boy presented with a history of recurrent acute pyelonephritis since the first year of life.His father had noticed that the boy voided with a forceful, but thin stream since his infancy. Physicalexamination revealed a pinpoint meatus resulting from fusion of the distal meatal margin at the normalposition. IVP showed mildly dilated calyces with clubbing on the right side. Voiding cystourethrographyrevealed external meatal stenosis and bilateral vesicoureteral reflux (grade 4 on the right, grade 3 on theleft).