거대 자궁근종으로 인한 양측 수신증 = Bilateral Hydronephrosis Caused by Huge Uterine Myoma

다국어 초록 (Multilingual Abstract)

A 67-year old woman was admitted due to left femur neck fracture. Pre-operative laboratory data revealed azotemia, and kidney ultrasonogram and pelvis MRI showed bilateral hydronephrosis and huge uterine myoma. On past history, she had uterine myoma since her thirties, but she refused to undergo operation. We initially planned percutaneous nephrostomy (PCN). After stabilization of renal function, we performed subsequent total hysterectomy after insertion of catheters on both ureters, and PCN catheters were removed after confirming that both ureteral catheters worked well. During follow up period of two months after PCN, renal function was gradually improved, but it was not normalized. Size of removed myoma was about 25×15 cm, and histopathologic findings were consistent with leiomyoma. In conclusion, myoma uteri is one of the rare causes of bilateral hydronephrosis, and it may lead to irreversible damage to kidney if left untreated for a long time.

참고문헌 (Reference)

1 윤상순, "폐경 후 성장한 거대 자궁근종 1예" 대한산부인과학회 44 (44): 629-632, 2001

2 Zeidel ML, "Urinary tract obstruction, In Brenner and Rector's The Kidney, 7th ed" 1867-1894, 2004

3 Schwartz Z, "Urinary retention caused by impaction of leiomyoma in pregnancy" 65 : 525-526, 1986

4 Hara T, "Ureteral obstruction in a transplanted kidney secondary to a subserous myoma uteri" 75 : 1915-1916, 2003

5 Klahr S, "The role of growth factors, cytokines, and vasoactive compounds in obstructive nephropathy" 18 : 622-632, 1998

6 Vieira JM Jr, "Simvastatin attenuates renal inflammation, tubular transdifferentiation and interstitial fibrosis in rats with unilateral ureteral obstruction" 20 : 1582-1591, 2005

7 Ishidoya S, "Pathophysiology and clinical implication of obstructive nephropathy" 94 : 645-655, 2003

8 Blight EM Jr, "Left Ureteral obstruction associated with uterine mass" 20 : 202-205, 1982

9 Konieczny H, "Hydronephrosis of the right kidney caused by compression of the bladder and the pelvic portion of the ureter by uterine myoma" 51 : 941-944, 1980

10 Kaneto H, "Enalapril reduces collagen type IV synthesis and expansion of the interstitium in the obstructed rat kidney" 45 : 1637-1647, 1994

11 Kim JH, "Effects of Enalapril on Synthesis of Collagen Type I, II, III in Incomplete Ureteral Obstruction with Uninephrectomized Rat" 42 : 1-9, 2001

12 Mizuguchi Y, "Atorvastatin ameliorates renal tissue damage in unilateral ureteral obstruction" 172 : 2456-2459, 2004

13 Ishidoya S, "Angiotensin II receptor antagonist ameliorates renal tubulointerstitial fibrosis caused by unilateral ureteral obstruction" 47 : 1285-1294, 1995

14 Ferreira EL, "Acute urologic symptoms associated with uterine myoma" 23 : 895-897, 1999

15 Novi JM, "Acute urinary retention caused by a uterine leiomyoma : a case report" 49 : 131-132, 2004

16 Courban D, "Acute renal failure in the first trimester resulting from uterine leiomyomas" 177 : 472-473, 1997

17 Kim YM, "A case of huge uterine myoma" 38 : 334-338, 1995