膀胱腫瘍の上部尿路に及ぼす影響について 第2篇: 臨床的考察

Abstract

In the previous report, statement was made that pat h ological changes of the upper urinary tracts are most frequently found in necropsied cases of cancer of the urinary bladder. The present report deals with the results of excretory urogram (IVP), PSP test, indigocarmine test and serum NPN determination performed in our clinical cases. All the tesults of examinations were obtained before operation. A total of 215 hospiterized patients with cancer of the urinary bladder were studied. These included 33 cases of low grade-low stage, 14 cases of low grade-high stage, 27 cases of high grade-low stage and 141 cases of high grade-high stage of the cancer. In viewin g excretory condition of contrast medium at IVP, bilaterally normal function was seen in 95.0 % of low grade-low stage cases and 40.5 % of high grade-high stage cases. The shape of the upper urinary tracts was found to be normally retained in 85.0 % of low grade-low stage cases, while it was normal in only 26.4 % of high grade-high stage cases. Normal excretion in PSP test was seen in 85.7 % of low grade-low stage cases and in 66.1 % of high grade-high stage cases. For indigocarmine test, 85.7 % of low grade-low stage cases and 35.3 % of high grade-high stage cases demonstrated bilateral normal results. The values of serum NPN showed within normal limits in 92.9 % of low grade-low stage cases and in 40.2 % of high grade-high stage cases. If one takes it in consideration that PSP test was not done in cases who had marked hematuria, about two-third of high grade-high stage cases are supposed to have some disturbances in the upper urinary tracts. For the treatment of bladder cancer, it has been emphasized that p ossibility of operative radical cure is merely decided by malignant charactor and grade of infiltration of the tumor itself. However, as clarified by our observations stated in the previous and present reports, in patient with cancer of the urinary bladder, disturbances of the upper urinary tracts are frequently seen even before the operation and renal insufficiency is confirmed to be the most frequent cause of death. For these reasons, an emphasis is made that the status of the upper urinary tract should be taken in deep consideration for treatment of this disease.