恥骨合併切除根治手術をおこなった原発性男子後部尿道癌の1例

Abstract

A 38-year-old male patient with the past history of polioencephalopathy was admitted with urinary retention and high grade fever. Although he was able to walk he had the intelligence of a 3-year-old child and his spine, thorax, fingers were deformed remarkably. Immediately after the admission, cystostomy was carried out and 600 ml of stinky and cloudy urine was noted. Although intensive antibiotic therapy was performed, high grade fever with leucocytosis (greater than 15,000/mm2) persisted for more than 10 days. Retrograde urethrogram showed stricture in the anterior urethra as well as irregular filling defect in the bulbomembranous urethra. After urethral dilation using urethral dilators, 18Fr nephrostomy balloon catheter was indwelled and the patient was discharged. However, the urethral irregular filling defect was unchanged and cytological examination of urine and urethral secretions revealed class V. After the readmission, endoscopic examination revealed papillary tumor lesions occupying the whole posterior urethra were found. With the diagnosis of invasive posterior urethral cancer, anterior exenteration by en bloc pubectomy, pelvic lymphadenectomy and ileal conduit urinary diversion were carried out. On the surgical specimen, the tumor occupied the bulbomembranous and prostatic urethra. Histopathological diagnosis was TCC G3 greater than SCC, stage B. Since the tumor invaded the serosa of the membranous urethra, we thought it could not be removed completely without the pubctomy.