尿閉で始まり診断の遅れた女性尿道腺癌

Delayed diagnosis of primary adenocarcinoma of the female urethra with a first symptom of urinary retention

　72歳女性が排尿困難で受診し，短期間で尿閉となった。膀胱鏡で尿道狭窄を認めたが，粘膜面の異常はなかった。間欠導尿を指導し精査を予定したが，他院に入院し尿道カテーテルを留置され，原因精査は看過された。初診から2年半後に性器出血で再診し，CT，MRIで尿道を取り巻き腟前壁に浸潤する腫瘍が判明した。生検の結果は腺癌で，放射線療法を行った。女性の尿排出障害では，稀な疾患であるが尿道癌の除外診断が必要と考えられた。

　A 72-year-old woman visited our hospital complaining of difficult voiding,which developed to urinary retention after a short period. Cystoscopy showed urethral stenosis,but there were no abnormal findings in the urethral mucosa. Urinary retention was managed by intermittent self-catheterization. Further investigation was planned,but cancelled by the patient. After she was admitted to another hospital,an indwelling urethral catheter was inserted but the cause of urinary retention was not investigated. Two years later she was referred to our hospital due to vaginal bleeding. CT and MRI revealed a tumor surrounding the urethra and invading partially to the anterior vaginal wall. Cystographic figures showed a mass with a BPH-like appearance that was pushing the bladder neck upward. The pathological diagnosis of needle biopsy specimen was mucinous adenocarcinoma. Though primary carcinoma of the female urethra is a rare disease,it must be considered in female patients with urinary retention.