腟パックテストが治療方針決定に有用であった完全子宮脱

A Case of Uterine Prolapse with Voiding Difficulty and Hydronephrosis:Vaginal Pack Test (Ghoniem Test) was Useful to Predict Postoperative Voiding State

　患者は下垂感と排尿困難で受診した完全子宮脱の58歳女性。IVPで両側水腎症。最大尿流率は7.5ml/sで，腟パックテスト（Ghoniem test）で性器脱を補正すると44.8ml/sに改善した。60分パッドテストは性器脱の状態，腟パックで補正した状態とも尿禁制で，予防的な尿失禁手術の必要性は低いと判断した。腟式子宮全摘，前後腟壁形成の施行で排尿困難と水腎症は消失し，尿失禁の発生もなかった。腟パックテストは性器脱手術後の排尿状態の予測に役立つと考えられた。

A 58-year-old postmenopausal woman complained of a protruding vaginal mass and voiding difficulty. A physical examination showed complete uterine prolapse and a severe cystocele. Intravenous pyelography showed bilateral mild hydronephrosis. The maximum flow rate was improved from 7.5 ml/s to 44.8 ml/s by vaginal pack test (Ghoniem test). Sixty-min pad test showed urinary continence in both conditions with or without the vaginal pack, suggest-ing that the necessity to perform anti-incontinence surgery at the time of the prolapse repair was low. The patient underwent a transvaginal hysterectomy and anterior/pos-terior colporraphy.