内視鏡的尿管切開術により腎保存し得た結核性尿管狭窄

Tuberculous Ureteral Stricture Treated with Endoureterotomy : A Case Report

　51歳，男性。発熱，右下腹部痛，肉眼的血尿，排尿痛，夜間頻尿を主訴に当科を紹介された。DIPでは両側腎杯の拡張および著明な右尿管狭窄を認めた。尿中結核菌を認めたため，INH,EB,RFPによる抗結核療法を開始し，経皮的右腎瘻造設2か月後に自覚症状および膀胱鏡所見は改善したものの，尿管狭窄が続くため内視鏡的尿管切開術を施行し，尿管ステントを約3か月間留置した。術後2年目の現在，再狭窄は認めない。

A 51-year-old man complaining of fever, right flank pain, macrohematuria, miction pain, and nocturia was admitted to our hospital. Cystoscopy revealed mucosal traction of right ureteral orifice. DIP showed bilateral hydrocalices and right lower ureteral stricture. Mycobacterium tuber-culosis was detected in urine, therefore INH, EB, RFP was given for 3 months. Right percutaneous nephrostomy was performed and antegrade pyelogram demonstrated com-plete obliteration of the distal ureter. Endoureterotomy was performed with full- thickness incision of the stricture using the cold knife in the 7-o'clock position.