泌尿器科診療におけるレーザー顕微鏡の応用

抄録

In recently, the confocal reflecting laser microscope (CRLM) has been used in our department for clinical urology, particularly patients with hematuria or male infertility, without requiring fixation and staining. Dysmorphic red blood cells are found in the urine of patients with glomerular bleeding, on the other hand isomorphic red cells characterize non-glomerular or urological bleeding. In this study, urine specimens from 50 patients with hematuria were collected (group A). Thirty three patients had urological disease and 17 had nephritis. The CRLM of the urine specimens showed a marked morphological difference between dysmorphic and isomorphic erythrocytes. The sensitivity and specificity for urological disease by CRLM were 100% and 93.9%, whereas those for nephritis were 100% and 76.5%. Urine specimens from 37 pediatric patients with hematuria (group B) were also observed by the CRLM: 35 had a glomerular disease, and 2 had a non-glomerular origin. Of 35 patients with glomerular disease, only 8 cases (22.9%) were classified as dysmorphic pattern and 11 (31.4%) were diagnosed as mixed pattern. The reason why of this result was supposed that 26 cases were already recieved treatment, and dysmorphism of urinary red cells with glomerular bleeding may be changeable corresponding with the condition of glomerular disease. By the way, semen specimens from 27 fertile men and 14 infertile men were collected. The sperm showed some morphological differences between fertile men and infertile by the CRLM. It was supposed that the good sperm had narrow sperm head, long sperm midpiece and wide acrosomal region of sperm head. From these results, it seems like that the CRLM makes it simpler and easier to evaluate the morphology of the erythrocyte in urine and sperm. The CRLM can be a good assistant diagnostic modality for patients with hematuria and investigative modality for male infertility.