膀胱腫瘍に対する回腸新膀胱(Hautmann法)の蓄尿・排尿状態の検討

Abstract

Hautmann型膀胱再建術中, 癌死・他因死・追跡不能を除く20例(男16例・女4例, 29～73歳)を対象に, 術後の回腸新膀胱の蓄尿・排尿状態を尿流動態検査(UDS)とアンケート調査により解析した.排尿回数は夜間に2回以上起床し排尿している例が19例中8例と高率であった.また, 尿失禁は19例中昼間2例, 就寝後12例にみられたが昼間は尿パッド平均2枚, 夜間は1枚で対処可能であった.排尿時間は18例中9例が1分以内に排尿を終えたが3例では3分以上を要した.排尿状態については18例中満足8例, 不満3例であった.USDを施行できたのは11例で観察期間は平均34.2±21.9ヵ月であった.残尿量は27.8±28.2ml, 新膀胱最大容量は395.2±96.8mlで膀胱内圧は充分に低値であった.排尿時, 外尿道括約筋筋電図で明らかな電位増強を11例中10例と高率に認めた

We analyzed the functional and urodynamic characteristics in 19 patients with ileal neobladder by the Hautmann procedure. A questionnaire survey by mail was performed for functional information of neobladder. Seventeen of the 19 patients (89.5%) could voluntarily void via the urethra and the others needed clean intermittent self catheterization (CIC) because of their significant residual volume. Eight of the 19 patients (42.1%) micturated at least two times at night. Two of the 19 patients (10.5%) were incontinent in the day time and 12 (63.2%) in the night time. They needed 2 pads in the day time and one pad at night on average. Eight out of 18 patients (44.4%) were satisfied with their micturition state. A urodynamic study showed the neobladder to be a low-pressure reservoir with a mean capacity of 395.2 +/- 96.8 ml. The mean residual volume of the patients without CIC was 27.8 +/- 28.2 ml. In 10 out of 11 patients high frequency and high amplitude spikes were seen by the perineal electromyogram in the voiding phase.