腎後性腎不全と二次性貧血を惹起した成人真性包茎

Renal Failure and Anemia Caused by True Phimosis

　45歳，男性。真性包茎による排尿困難を15年間放置していたところ，食思不振，倦怠感，体重減少が出現した。血液検査では腎機能の低下と貧血を認め，腹部超音波およびCT検査では著明な両側水腎水尿管症と膀胱壁の全周性肥厚を認めた。背面切開術により症状および検査所見の改善をみた。真性包茎による腎後性腎不全，慢性尿路感染症およびこれらによる二次性貧血と診断した。

A 45-year-old man presented with symptoms of lassitude, loss of appetite and weight loss. He had been suffering from difficult voiding due to stenotic preputial orifice for fifteen years. Initial laboratory data revealed serum creatinine of 6.2 mg/dl and hemoglobin of 7.4 g/dl. An abdominal ultra-sound (US) showed bilateral ureteropyelocaliectasis and the bladder wall thickening. We performed a dorsal slit of the prepuce and drained infected urine of 1100 ml. Urinary tract infection was treated with cefaclor. After operation a remarkable improvement of voiding stream was noted and other complaints quickly disappeared.