根治的前立腺全摘除術後の膀胱頸部狭窄に関する検討 - 発生頻度および危険因子について -

Abstract

1995～2001年に前立腺全摘術を施行した99症例を対象に, 術後の膀胱頸部狭窄(BNC)の発生頻度, 予後, 危険因子を検討した.術後平均7ヵ月に, BNCは10例(10%)にみられた.ブジーあるいは内尿道切開術を施行した.平均11ヵ月後に5例が再発し, 再度内尿道切開術を施行した.危険因子の同定のため13因子をパラメーターとして単変量解析を行った結果, 手術年度, 膀胱尿道吻合法, 手術時間, 出血量, 術者において有意差を認めた.多変量解析では, モデルを安定化させるため手術時間と膀胱尿道吻合法を除き上位5因子をパラメーターとして解析を行った結果, 手術年度(1998年以前)と術者(経験症例数5例以下)がBNCの危険因子であった

We retrospectively analyzed the morbidity and risk factors of bladder neck contraction (BNC) after retropubic prostatectomy. Of 99 consecutive patients who underwent radical retropubic prostatectomy between 1995 and 2001, 10 (10%) developed anastomotic stricture after surgery. BNC was diagnosed 7 months on average after the surgery. Nine patients were successfully treated by cold-knife incision, but 5 required additional incision against the recurrence of BNC. None of them revealed newly diagnosed stricture or incontinence. Thirteen potential risk factors including age, stage, PSA, neoadjuvant treatment, pathology, intraoperative blood loss, operation time, operator, nerve sparing, extravasation of urine, marginal status, the year of operation, and the method of ureterovesical anastomosis were evaluated using univariate and multivariate analysis. The BNC rate was increased in patients with longer (more than 4 hrs) operations and excessive bleeding (more than 1, 000 ml) (p=0.0027, respectively). The year of operation (before 1998, p=0.0015), the method of ureterovesical anastomosis (p=0.0017), operator experience (less than 5 cases, p=0.0056), and neoadjuvant treatment (p=0.09) were also risk factors. In multivariate analysis, the year of operation (p=0.03) and operator experience(p=0.04) were strong predictors of BNC. The skill levels of surgeons and institutes are expected to decrease BNC.