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

腎摘除術後の対側腎の代償性肥大と腎機能の変移

腎摘除術後の対側腎の体積と腎機能の変移を検討した.対象は腎細胞癌で腎摘除術を受け, 対側腎に明らかな異常がなく, 当院で少なくとも2年以上経過観察している25例であった.25例中12例で毎年CT検査を受けていた.腎の体積は造影CT上の腎の3方向の径を測定し楕円体体積の公式に当てはめて求めた。対側腎の体積は術後3年目まで増加し, 術前体積(100%)に比べて2～7年後の平均最終体積は120%であった.対側腎の腎摘前の体積と術後の最終体積の間に有意な相関はなかったが, 術前に小さい腎は腎摘後の最終体積比率が大きい傾向にあった.血清クレアチニン値は術後1年目に有意に増加したが, 1年目の値に比べてその後数年の経過で有意に低下した.つまり, 代償性腎肥大と腎機能の改善は術後数年以内に完成されるものの, 腎肥大に比べて血清クレアチニン値の改善は遅れた.この理由として, 術後早期の腎血漿流量の増加に伴って代償性腎肥大は起こるが, 糸球体濾過率の上昇は2-一一3年遅れるため, 上昇していた血清クレアチニン値の低下も遅れたことが考えられた.We studied the changes in the serum creatinine level and the volume of the remaining kidney following nephrectomy using contrast-enhanced compounded tomogram (CT) scans. Twenty-five patients undergoing nephrectomy for renal cell carcinoma without obvious disease in the remaining kidney were carefully followed for a period of at least two years at our hospital. Twelve patients received follow-up CT scans each year after nephrectomy. The ellipsoid volume of the kidney was calculated by measuring the 3-dimensional size on CT scans. The mean relative volume (%) of the remaining kidney increased up to year 3 postoperatively, and the final mean relative volume at varying periods from years 2 to 7 was 120%. Kidneys that were smaller prior to nephrectomy showed a tendency to have a larger final relative volume after nephrectomy, although there was no significant correlation between the kidney volume prior to nephrectomy and at final measurement. The mean serum creatinine level was significantly increased at one year after nephrectomy, but it decreased significantly over time. Therefore, both compensatory renal hypertrophy and improved renal function seemed to be established within several years after nephrectomy. However, the improvement of serum creatinine was delayed compared with the increase of kidney volume. That is, renal plasma flow might be increased early by compensatory renal hypertrophy, followed within a few years by an increase in glomerular filtration and a decrease of serum creatinine

Suppression of detrusor-sphincter dysynergia by GABA-receptor activation in the lumbosacral spinal cord in spinal cord-injured rats

We investigated the effects of intrathecal application of GABAA- or GABAB-receptor agonists on detrusor-sphincter dyssynergia (DSD) in spinal cord transection (SCT) rats. Adult female Sprague-Dawley rats were used. At 4 wk after Th9-10 SCT, simultaneous recordings of intravesical pressure and urethral pressure were performed under an awake condition to examine the effect of intrathecal application of GABAA and GABAB agonists (muscimol and baclofen, respectively) or GABAA and GABAB antagonists (bicuculline and saclofen, respectively) at the level of L6-S1 spinal cord. In spinal-intact rats, the effects of bicuculline and saclofen on bladder and urethral activity were also examined. During urethral pressure measurements, DSD characterized by urethral pressure increases during isovolumetric bladder contractions were observed in 95% of SCT rats. However, after intrathecal application of muscimol or baclofen, urethral pressure showed urethral relaxation during isovolumetric bladder contractions. The effective dose to induce inhibition of urethral activity was lower compared with the dose that inhibited bladder contractions. The effect of muscimol and baclofen was antagonized by intrathecal bicuculline and saclofen, respectively. In spinal-intact rats, intrathecal application of bicuculline induced DSD-like changes. These results indicate that GABAA- and GABAB-receptor activation in the spinal cord exerts the inhibitory effects on DSD after SCT. Decreased activation of GABAA receptors due to hypofunction of GABAergic mechanisms in the spinal cord might be responsible, at least in part, for the development of DSD after SCT

Effect of duloxetine, a norepinephrine and serotonin reuptake inhibitor, on sneeze-induced urethral continence reflex in rats

We investigated the effect of duloxetine, a norepinephrine (NE) and serotonin (5-HT) reuptake inhibitor, on the neurally evoked urethral continence reflex induced by sneezing in rats. To clarify the role of noradrenergic and serotonergic mechanisms in preventing stress urinary incontinence (SUI) during sneezing, we examined the effect of duloxetine followed by intrathecal (it) methiothepin maleate (5-HT receptor and α1-adrenoceptor antagonist) or terazosin or idazoxan (selective α1- and α2-adrenoceptor antagonists, respectively). Amplitude of urethral pressure responses during sneezing (A-URS), urethral baseline pressure (UBP) at the midurethra, and sneeze-induced leak point pressure (S-LPP) were measured in normal adult female rats and rats with SUI induced by vaginal distension (VD). In normal and VD rats, intravenous application of duloxetine (1 mg/kg) increased A-URS by 35% and 34% and UBP by 21% and 34%, respectively. Sneezing-induced fluid leakage from the urethral orifice was observed in VD rats but not in normal rats. S-LPP was increased from 39.1 to 92.2 cmH2O by intravenous duloxetine in incontinent VD rats. Duloxetine-mediated enhancement of A-URS was inhibited by terazosin but not methiothepin maleate (it). In addition, simultaneous intrathecal application of methiothepin and terazosin induced a reduction in A-URS during sneezing, which was not increased by intravenous duloxetine. However, the reduced A-URS after intrathecal application of methiothepin and terazosin returned to the control level when duloxetine (iv) was applied after intrathecal idazoxan administration. These results indicate that duloxetine can prevent SUI by facilitating noradrenergic and serotonergic systems in the spinal cord to enhance the sneeze-induced active urethral closure mechanism