尿路結石症の研究 第20報: 上部尿路結石症の治療

Abstract

1. 561 cases of urolithiasis were treated at our d e partment from January 1949 to December 1959. The percentage of these cases amounted to 3.22 of all urological outpatients during this period. 2. Thes e 561 cases consist of 120 cases or 20.4 percent of renal calculi, 293 cases or 50.3 percent of ureteral calculi and 171 cases or 29.3 percent of lower urinary tract calculi. The frequency of lithiasis of upper urinary tract is remakably increased year by year, while that of the lower urinary tract remains stationary That is to say that the phenomenon of so-called "stone wave" can be well recognized at our department. 3. Among these cases nephrectomy was performed on 37 cases. The cause of 29 cases of the primary nephrectomy was mainly urosepsis and functionless hydronephrosis due to calculi. The cause of cases of the secondary nephrectomy was mostly urinary fistula. Because of post-operative bleeding after partial nephrectomy, secondary nephrectomy was performed in one case. 4. A devic e to mange the renal pedicle safely in the subcapsular nephrectomy was suggested. 5. Our method of nephroilthotomy and renal bisection was described. 6. In order to take a photograph during the operation, a p o rtable Thulium-170 x-ray unit was made. 7. A s uccessful case of solving a rest calculus after nephrolithotomy with Versene solution was reportd. 8. Pe n diomid, a ganglion blocking agent, was applied successfully for a case of heavy bleeding after nephrectomy. 9. Coagulu m pyelolithotomy of Dr. Dees was tried in 14 cases. Fundamental studies to increase the tensile strength of the fibrincoagulum were described. 10. Spontaneous expulsion of the ureteral calculus w a s observed in 28.3 percent of our casees, while energetic treatment to force spontaneous expulsion increased the percentage to 53.4 of 103 cases 11. Lite r atures on the cystoscopic removal of the ureteral calculus were reviewed. 73.1 % our expulsion cases including those of spontaneous expulsion after cystoscopic extraction maneuvers was successful. 12. Operative indicati o n and method of the ureterolithotomy were discussed. Foley's lumbar ureterolithotomy and . Ulm's half Cherney incision were recommended as methods of choice. 13. Fifteen cases of bilateral lithiasis were presented and surgical problems concering them were discussed. 14. A c a se report of ureteric empyema due to a calculus was described, which presented symptoms for the first time 18 years after nephrectomy 15. Seven cases of upper urinary tract l i thiasis under special circumstances (upper urinary tract calculosis in children, pregnancy & upper urinary tract calculosis, calculosis in a solitary kidney, combination of urinary tract anomalies & calculosis, combination of renal tubcurosis & calculosis, combination of upper urinary tract tumors & calculosis, calculosis of the recumbent, calculosis medicamentosa) were reported and the Japanese literatures concering them were reviewed.