皆川 倫範, 村田 靖

Tomonori MINAGAWA, Yasushi MURATA

安曇野赤十字病院泌尿器科

Department of Urology, Azumino Red Cross Hospital

キーワード : ultrasound, sonourethrography, urethra, urethral stricture, urethral injury

目的：男性尿道に液体を満した状態で観察する超音波検査（ソノウレスログラフィー）を経皮及び経直腸超音波検査を用いて施行し，その臨床的有用性を明らかにする．対象と方法：尿道カテーテル留置困難症例，尿道狭窄症例，尿道外傷症例を対象にソノウレスログラフィーを施行した．カテーテル留置困難症例と尿道外傷では仰臥位で，尿道狭窄症例では載石位で検査を行った．カテーテル留置困難症例では経直腸超音波検査のみでソノウレスログラフィーを施行し，カテーテル留置困難の原因を評価した．尿道狭窄症例では経皮経直腸併用ソノウレスログラフィーで尿道全長を観察し，尿道狭窄の場所，狭窄部位の数，狭窄の長さを評価した．尿道狭窄症例の全例で経尿道的内尿道切開術を施行し，ソノウレスログラフィーの所見と術中所見を比較した．尿道外傷症例では経直腸超音波検査のみでソノウレスログラフィーを施行し，尿道内腔の確認，尿道周囲の血腫の観察を行った．結果と考察：対象症例は10例であった．カテーテル留置困難症例は偽尿道2例，前立腺肥大症2例，正常尿道1例であった．何れの症例でも尿道の形態を十分に観察が可能で，さらにその所見をもとにカテーテル先端を誘導し，安全なカテーテルの留置が可能であった．また，尿道狭窄症例は4例で，そのうち3例は球部狭窄で，1例は前立腺全摘術後吻合部狭窄の症例であった．球部狭窄は経皮ソノウレスログラフィーで，吻合部の狭窄は経直腸ソノウレスログラフィーで鮮明に観察することが出来た．何れの症例でも狭窄の詳細な評価が可能で，術中所見と一致した．尿道外傷症例では尿道内腔の連続性，尿道周囲の血腫，偽尿道を鮮明に観察することが可能であった．重篤な有害事象を認めることなく，全例で安全に検査を施行することが出来た．結論：ソノウレスログラフィーは経皮と経直腸を併用することにより尿道全長の観察が可能である．ソノウレスログラフィーは尿道狭窄，偽尿道，尿道外傷の診断に有用で，カテーテル留置の補助となる．

Purpose: The aim of this study was to determine if transcutaneous and transrectal ultrasonography of the male urethra with retrograde jelly injection into the urethra (sonourethrography) was clinically useful. Subjects and Methods: Sonourethrography was performed in cases in which indwelling urethral catheter insertion was difficult, cases with urethral stricture, and a case with urethral injury. Cases with urethral stricture were placed in the lithotomy position. Cases in which indwelling urethral catheter insertion was difficult and the case with urethral injury were placed in the supine position. In the cases with urethral stricture, transcutaneous and transrectal sonourethrography was performed and the urethra was observed from the anterior urethra to the bladder neck. The location, number, and length of urethral strictures were evaluated. In the cases in which indwelling urethral catheter insertion was difficult and the case with urethral injury, only transrectal sonourethrography was performed. The reason for the difficulty of indwelling urethral catheter insertion and the continuous urethral lumen after injury were evaluated. Sonourethrography-guided urethral catheter insertion was also performed. Results and Discussion: Five cases in which indwelling urethral catheter insertion was difficult, four cases of urethral stricture, and one case of urethral injury were enrolled. Two cases of false tracts, two cases of benign prostate hyperplasia, and one case of normal urethra made up the cases in which indwelling urethral catheter insertion was difficult. In all five cases, the reason for the difficulty of indwelling catheter insertion were identified, and sonourethrography-guided indwelling urethral catheter insertion was effective and safe. Of the four cases of urethral stricture, three cases were bulbar urethral strictures and one case was anastomotic urethral stricture after radical prostatectomy. In all cases, the strictures were clearly observed using sonourethrography. The anastomotic urethral stricture after radical prostatectomy was clearly observed using transrectal sonourethrography. In all of the cases of urethral stricture, the stricture findings were the same as the intraoperative urethroscopic findings. In the case of urethral injury, continuous urethral lumen, hematoma around the urethra, and false tract were observed. Severe adverse events were not seen in any cases. Conclusion: Anatomical evaluation of the male urethra from the anterior urethra to the bladder neck can be precisely done using transcutaneous and transrectal sonourethrography. In addition, sonourethrography can be used to reliably and safely assist indwelling urethral catheter insertion.