尿閉による尿路感染・腸腰筋膿瘍のため、術前管理に苦慮した腹腔鏡下仙骨腟固定術の１例

抄録

　Pelvic organ prolapse often leads to urinary retention, but rarely to serious urinary tract infection. In this report, we describe a case of laparoscopic sacrocolpopexy for urinary tract infection due to urinary retention caused by pelvic organ prolapse, which developed into an iliopsoas muscle abscess and was difficult to manage preoperatively.

　The patient was 68 years old, (gravida, 2; para, 2), and visited our department for surgery for pelvic organ prolapse. Since she was able to urinate, she was managed as an outpatient. She visited our department again 31 days after her first visit, with complaint of fever, back pain, and left hip pain. Computed tomography (CT) led to diagnosis of iliopsoas abscess and she was admitted to the hospital for management. After admission, the patient underwent CT-guided drainage and antimicrobial therapy. The infection was controlled relatively quickly, but long-term rehabilitation was required, and the patient was transferred to a rehabilitation hospital on day 59 of admission. One month after discharge from the hospital, the iliopsoas abscess had completely disappeared on CT, and laparoscopic sacrocolpopexy was performed 6 months after discharge. The operation was performed in the supine position due to leg opening restrictions, with an operative time of 285 minutes and a blood loss of 60 ml. We removed the bladder catheter on postoperative day 1 without urinary retention, and the patient was discharged from the hospital on postoperative day 5 without any signs of infection.

　In this case, we experienced an iliopsoas abscess due to urinary retention associated with pelvic organ prolapse and a laparoscopic sacrocolpopexy after healing. Pelvic organ prolapse is often associated with urinary retention, and patients who require a prolonged surgical wait should be managed with the risk of developing serious complications in mind, as in this case.