女児尿道ポリープの1例

Urethral polyps are rarely found in young girls. A total of 12 urethral polyps have been described in young girls in the English literature to date. Here we present a case of urethral polyp that was detected in the distal urethra of a 12-year-girl. Her chief complaint was a sudden blood discharge. On examination, a 15 x 9 mm polypoid mass with a 7 mm pedicle was seen protruding from the urethral meatus. The mass was excised under general anesthesia. Histopathologically, the polyp was covered with urothelium and squamous epithelium, and was composed of congested blood vessels and inflammatory infiltrates. These findings were similar to those of urethral caruncles in postmenopausal female. She has been free from recurrence and has had no complications, as of 12 months after excision.症例は12歳, 女児。生来健康。約1年前より外尿道口から脱出する腫瘤に気付くも症状なく放置していた。2005年10月に外陰部より突然の出血を認めたため, 近医を受診。外尿道口より脱出する小指頭大のポリープを認め, 同年10月31日, 精査加療目的に当院紹介となった。受診時, 他に理学所見上, 特に異常認めず, また尿沈渣, 血液学的検査, エコー, IVPなどにおいても異常所見を認めなかった。同年11月10日全身麻酔下, 尿道膀胱鏡および尿道ポリープ切除術を施行した。尿道鏡にて前部尿道の6時にポリープの起始部を認めた。膀胱内に特に異常所見は認めなかった。起始部からポリープを鋭的に切除し, 欠損部を5-0 PDSにて縫合した。術後経過は良好で術後1日目に尿道カテーテル抜去, 2日目に退院となった。病理組織学的検査にて尿道ポリープは移行上皮および扁平上皮に覆われ, 上皮下組織に小血管の増生と著明な炎症細胞の浸潤を認め, 尿道カルンクラに非常に類似していた。腫瘍性変化や異型細胞の増殖は認めなかった。現在, 術後1年が経過しているが, 再発, 合併症など認めていない。小児における尿道ポリープは稀な疾患であるが, 男児に比べ女児における報告はさらに少ない。われわれが調べうる限り12例の女児尿道ポリープが報告されている。またBen-Meirらは思春期前の女児尿道ポリープの5症例を検討し, 病理組織学的に尿道カルンクラとの類似性を指摘している。今回, われわれは女児尿道ポリープの1例を経験したので若干の文献的考察を加え, ここに報告する。(著者抄録

Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children

Vesicoureteral reflux (VUR) is one of the most common diseases in pediatric urology and classified into primary and secondary VUR. Although posterior urethral valve (PUV) is well known as a cause of the secondary VUR, it is controversial that minor urethral deformity recognized in voiding cystourethrography represents mild end of PUV spectrum and contributes to the secondary VUR. We have been studying for these ten years congenital urethral obstructive lesions with special attention to its urethrographic and endoscopic morphology as well as therapeutic response with transurethral incision. Our conclusion to date is that congenital obstructive lesion in the postero-membranous urethra is exclusively PUV (types 1 and 3) and that severity of obstruction depends on broad spectrum of morphological features recognized in PUV. Endoscopic diagnostic criteria for PUV are being consolidated

Importance and difficulty of correctly diagnosing covered cloacal exstrophy for adequate reconstruction: A case report

Covered cloacal exstrophy (CCE) is extremely rare condition. In patients with a single perineal orifice and no pubic bone separation, it is very difficult to suspect and/or diagnose CCE based on external signs alone. We present the case of a 2-month-old girl diagnosed with CCE based on cystography, ileostomy contrast study and cystoscopy

Pediatric Primary Alveolar Soft Part Sarcoma of the Bladder

A 9-year-old girl was diagnosed with primary alveolar soft part sarcoma of the bladder after imaging examinations and transurethral resection (TUR) of the bladder tumor. As a positive surgical margin of the TUR indicated residual tumor cells, we performed a cystourethrectomy to remove the tumor. A continent urinary reservoir for self-catheterization was constructed using the Mainz pouch technique, and an abdominal (umbilical) continent catheterizable stoma using the appendix was performed. For 2.5 years postoperatively, the patient remained free of local recurrence and distant metastasis. The patient’s clinical course has been favorable, with good management of clean intermittent self-catheterization