我が教室に於ける過去32年間の尿路結石症の統計的観察

Abstract

A statistical observation was made on 861 cases of urolithiasis experienced during the past thirty-two years, 1928 to 1959. 92 of them showed multilocation of stones in the urinary tract. They consisted of 221 cases (25.6%) of renal calculus, 291 (33.7%) of ureteral, 252 (29.2%) of vesical, 54 (6.2%) of urethral and 43 (4.9%) of prostatic. In the early period of above 32 years, calculus in the lo w er urinary tract showed higher incidence than that of the upper, but this ratio lately reversed with greatly increasing incidence of upper urinary tract calculus. Age distribution of calculus was 223 cases (25.9%) in the third decade, 182 (21.1%) in the fourth decade. In young adults, there were many cases of calculus of the upper urinary tract ; on the other hand, there were many cases of the lower urinary tract calculus in the aged and children. 729 cas e s (84.6%) were male and 132 cases (15.3%) were female. The ratio of male to female on sites of stones was 3.2 to 1 in renal calculus, 4.2 to 1 in ureteral, 9.1 to 1 in vesical and 54 to 0 in urethral. By occupations, farm er was in the first and business man was in the next place. In the upper urinary calculus, the ratio of renal to ureteral calculus was 1 to 1.3. Affected side was a little more on the left than the right. Ureteral stones were found more in the lower ureter than in the upper or mid-ureter. Male to female ratio of upper urinary calculus was 3.7 to 1, highest incidence of which was seen in the trird decade in both male and female. V e sical calculus showed highest incidence in the seventh decade and next in the fifth decade. It was interesting that 30 cases (11.8%) of vesical calculus were found in one to ten years of age. Urethral c alculus occupied 6.8% of all urinary calculus and was most frequent in one to sixten years of age, but there was no case of female. Prostatic calculus was mostly seen in man over 40 and occupied 5.09% of all urinary calculus. As far as the treatment of urolithiasis is concerned, in the early periods, those who received treatment for urinary calculus were only 44.8% of all the urolithiatic patients occupying 2.4% of outpatients. Recently, however, cases of urolithiasis have progressively increased and those who received treatment became more than 50%. Treatment of urolithiasis was, as a whole, surgical. When t h ere was a stone only in the upper urinary tract operative treatment was common, but it should be noted that cases of spontaneous discharge or chemical dissolution of stones have been recently increasing. In cases of vesical or urethral calculus, endoscopic treatment was widely used ; and in cases with prostatic calculus, treatment was all operative. Chemical composition of calculus showe d much phosphate in upper urinary and urate in lower urinary calculus.