臨床泌尿器科67巻3号

2013年03月発行

特集 前立腺全摘除術後の合併症―予防と対処

前立腺全摘除術後の尿路直腸瘻

著者： 小池宏¹ 鳥羽智貴¹

所属機関： ¹新潟労災病院泌尿器科

ページ範囲：P.197 - P.205

文献概要

要旨　尿路と直腸との間に生じる尿路直腸瘻（urorectal fistulaもしくはrectourinary fistula）は，厳密には尿道直腸瘻（urethrorectal fistulaもしくはrectourethral fistula）と膀胱直腸瘻（vesicorectal fistulaもしくはrectovesical fistula）とに分けられる。前立腺全摘除術後に直腸と尿路の間に生じる瘻孔の多くは膀胱尿道吻合部の近くから膜様部尿道に生じるが，一部は膀胱縫縮部から生じるので，ここでは尿路直腸瘻（以下，URFと略す）という名称を用いる。URFに対する修復術にはさまざまな到達方法があり，それぞれの方法により特徴が異なるため，個々の症例の状況に応じて到達方法を考える必要がある。前立腺全摘除術後に生じるURFは難治性であり，時に治療に難渋する症例も存在するが，経会陰的到達法で瘻孔切除を行い，血流の良好ななんらかの有茎弁を間置・充塡することで，良好な治療成績が期待できる。

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