全腹腔鏡下子宮全摘出術時に偶発的に発見された異所性尿管瘤を伴う両側完全重複腎盂尿管の1例

抄録

  It is thought that the risk of ureteral injury is greater with total laparoscopic hysterectomy (TLH) than with abdominal surgery. Cystoscopy is sometimes useful to confirm a urinary system complication during TLH. We report a case of bilateral complete double renal pelvis and ureter. A 44 year-old woman was seen for treatment of uterine myoma. As she had hypermenorrhea and anemia due to a uterine myoma, we scheduled surgery. At the initial visit, she complained of hypermenorrhea and prolonged menstruation, and had a hemoglobin level of 8.9 g/dl. Transvaginal sonography and magnetic resonance imaging revealed a 60-mm uterine myoma. TLH was performed without difficulty. The operative time was 163 minutes and blood loss was 100 g. In this hospital, we examine the bladder using cystoscopy during surgery in all TLH cases, and also determine the presence of any urinary tract complications. In the present case, cystoscopy revealed a complete double ureteral orifice. This finding was also confirmed laparoscopically. With the diagnosis of a double ureter, we performed postoperative computed tomography, and identified a complete double renal pelvis and ureter with an ectopic ureterocele. The patient did not require treatment and is doing well after discharge. In general, we perform cystoscopy to identify urinary tract complications. However, urinary tract anomalies are sometimes incidentally found, and their identification can help to prevent complications.